CT-hersenen bij verdenking op meningitis? Eerst antibiotica!

A lumbar puncture (LP) is often essential for the diagnosis of bacterial meningitis. An LP can worsen brain displacement in case of a space-occupying lesion. Therefore, in selected patients a CT scan of the brain is made prior to performing the LP. However, the level of agreement between experts in diagnosing a contraindication for LP on CT scan is low. More importantly, in a substantial part of patients, empirical treatment with antibiotics was delayed due to the CT scan being performed first. The only effective treatment for patients with bacterial meningitis is early administration of antibiotics. Therefore, delay in administrating antibiotics should be prevented. Thus, should a CT scan of the brain be indicated, antibiotic treatment should be started before said imaging diagnostics and/or a potential LP procedure.

Conflict of interest and financial support: none declared.