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These include obtaining blood cultures, performing lumbar puncture and initiating appropriate therapy, while avoiding harmful delays such as those that result from not administering treatment until neuroimaging has been performed. Despite the increasing availability of newer diagnostic techniques, the interpretation of cerebrospinal fluid parameters remains a vital skill for clinicians. International and local guidelines differ with regard to initial empirical therapy of bacterial meningitis in adults; the North American guideline recommends ceftriaxone and vancomycin for all patients, while the Australian, UK and European guidelines recommend that vancomycin only be added for patients who are more likely to have pneumococcal meningitis or who have a higher likelihood of being infected with a strain of\n                    <jats:italic>Streptococcus pneumoniae<\/jats:italic>\n                    with reduced susceptibility to ceftriaxone. Patients with risk factors for\n                    <jats:italic>Listeria<\/jats:italic>\n                    meningitis also require an anti\u2010\n                    <jats:italic>Listeria<\/jats:italic>\n                    agent, such as benzylpenicillin, to be added to this treatment regimen. Dexamethasone should be a routine component of empirical therapy due to its proven role in reducing morbidity and mortality from pneumococcal meningitis.\n                  <\/jats:p>","DOI":"10.1111\/imj.14102","type":"journal-article","created":{"date-parts":[[2018,11,1]],"date-time":"2018-11-01T20:11:12Z","timestamp":1541103072000},"page":"1294-1307","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":89,"title":["Meningitis in adults: diagnosis and management"],"prefix":"10.1111","volume":"48","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1610-538X","authenticated-orcid":false,"given":"Nicholas","family":"Young","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases Auckland City Hospital Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9381-7623","authenticated-orcid":false,"given":"Mark","family":"Thomas","sequence":"additional","affiliation":[{"name":"Department of Infectious Diseases Auckland City Hospital Auckland New Zealand"},{"name":"Department of Molecular Medicine and Pathology University of Auckland Auckland New Zealand"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,11]]},"reference":[{"key":"e_1_2_7_2_1","first-page":"1097","volume-title":"Principles and Practice of Infectious Diseases","author":"Tunkel AR","year":"2015"},{"key":"e_1_2_7_3_1","first-page":"CD004405","article-title":"Corticosteroids for acute bacterial meningitis","author":"Brouwer MC","year":"2015","journal-title":"Cochrane Database Syst Rev"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1590\/0004-282X20130144"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/civ011"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2015.02.023"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/qjmed\/hci047"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa040845"},{"key":"e_1_2_7_9_1","volume-title":"Invasive Meningococcal Disease","author":"Australian Government Department of Health","year":"2017"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.00008-11"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1086\/508462"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2009.075598"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa010399"},{"key":"e_1_2_7_14_1","doi-asserted-by":"publisher","DOI":"10.1086\/425368"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2016.01.007"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.3109\/00365548.2013.799289"},{"key":"e_1_2_7_17_1","doi-asserted-by":"publisher","DOI":"10.1080\/23744235.2016.1269265"},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cix806"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.282.2.175"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jinf.2016.01.007"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1128\/CMR.5.2.130"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1086\/322597"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2013.11.030"},{"key":"e_1_2_7_24_1","first-page":"1103","article-title":"Cerebrospinal fluid analysis","volume":"68","author":"Seehusen D","year":"2003","journal-title":"Am Fam Physician"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1155\/2014\/568169"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM197309132891108"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s15010-015-0867-6"},{"key":"e_1_2_7_28_1","first-page":"1","article-title":"Diagnosis of tuberculous meningitis: challenges and promises","volume":"37","author":"Philip N","year":"2015","journal-title":"Malays J Pathol"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1515\/cclm-2014-0077"},{"key":"e_1_2_7_30_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.1989.03430190084036"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1473-3099(07)70050-6"},{"key":"e_1_2_7_32_1","volume-title":"Therapeutic Guidelines: Antibiotic. 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