Bacterial meningitis--the importance of cerebro-spinal fluid examination

The role of lumbar puncture in bacterial meningitis has been debated in recent years, especially in the presence of worsening headache, alteration of conscious level, focal neurological signs, papilloedema or a haemorrhagic rash. However valuable bacteriological and epidemiological information will be lost if lumbar puncture is avoided, despite blood cultures being taken. This loss of information will be highlighted if pre-admission antibiotics are administered (this should now be standard practice).