The Practice Guidelines for the Management of Bacterial Meningitis provide recommendations for the diagnosis and treatment of bacterial meningitis. These guidelines emphasize the importance of early recognition of meningitis syndrome, rapid diagnostic evaluation, and emergent antimicrobial and adjunctive therapy. The guidelines are based on data published through May 2004 and are intended for clinicians managing patients with suspected or proven bacterial meningitis. The initial management approach for suspected bacterial meningitis involves obtaining blood samples for culture and performing a lumbar puncture to determine whether the CSF findings are consistent with the clinical diagnosis. In some cases, a CT scan of the head may be performed before lumbar puncture, particularly in patients with elevated intracranial pressure or a history of CNS disease. However, the risk of complications from lumbar puncture in these patients is not well understood, and the decision to perform a CT scan should be based on specific criteria. The diagnosis of bacterial meningitis is confirmed by CSF examination, including Gram stain, which can identify the causative bacterium in 60%–90% of patients with community-acquired bacterial meningitis. Additional tests, such as latex agglutination and PCR, may be used to aid in the etiologic diagnosis. However, the routine use of these tests is not recommended for the rapid determination of the bacterial etiology of meningitis. The choice of antimicrobial therapy depends on the patient's age, the suspected pathogen, and the results of CSF analysis. For infants and children, empirical antimicrobial therapy with vancomycin combined with either cefotaxime or ceftriaxone is recommended pending culture results. For adults, targeted antimicrobial therapy is based on the results of CSF Gram stain. Adjunctive dexamethasone therapy may be considered in certain patients with bacterial meningitis, particularly in infants and children with H. influenzae type b meningitis. However, its use in pneumococcal meningitis is controversial, and the evidence is not sufficient to recommend its use in all cases. The guidelines also emphasize the importance of initiating antimicrobial therapy as soon as possible after the diagnosis of bacterial meningitis is suspected or proven. Delayed treatment may increase the risk of morbidity and mortality. The specific antimicrobial agents and dosages are recommended based on the isolated pathogen and susceptibility testing. The guidelines also provide recommendations for the use of adjunctive dexamethasone therapy in adults with suspected or proven pneumococcal meningitis.The Practice Guidelines for the Management of Bacterial Meningitis provide recommendations for the diagnosis and treatment of bacterial meningitis. These guidelines emphasize the importance of early recognition of meningitis syndrome, rapid diagnostic evaluation, and emergent antimicrobial and adjunctive therapy. The guidelines are based on data published through May 2004 and are intended for clinicians managing patients with suspected or proven bacterial meningitis. The initial management approach for suspected bacterial meningitis involves obtaining blood samples for culture and performing a lumbar puncture to determine whether the CSF findings are consistent with the clinical diagnosis. In some cases, a CT scan of the head may be performed before lumbar puncture, particularly in patients with elevated intracranial pressure or a history of CNS disease. However, the risk of complications from lumbar puncture in these patients is not well understood, and the decision to perform a CT scan should be based on specific criteria. The diagnosis of bacterial meningitis is confirmed by CSF examination, including Gram stain, which can identify the causative bacterium in 60%–90% of patients with community-acquired bacterial meningitis. Additional tests, such as latex agglutination and PCR, may be used to aid in the etiologic diagnosis. However, the routine use of these tests is not recommended for the rapid determination of the bacterial etiology of meningitis. The choice of antimicrobial therapy depends on the patient's age, the suspected pathogen, and the results of CSF analysis. For infants and children, empirical antimicrobial therapy with vancomycin combined with either cefotaxime or ceftriaxone is recommended pending culture results. For adults, targeted antimicrobial therapy is based on the results of CSF Gram stain. Adjunctive dexamethasone therapy may be considered in certain patients with bacterial meningitis, particularly in infants and children with H. influenzae type b meningitis. However, its use in pneumococcal meningitis is controversial, and the evidence is not sufficient to recommend its use in all cases. The guidelines also emphasize the importance of initiating antimicrobial therapy as soon as possible after the diagnosis of bacterial meningitis is suspected or proven. Delayed treatment may increase the risk of morbidity and mortality. The specific antimicrobial agents and dosages are recommended based on the isolated pathogen and susceptibility testing. The guidelines also provide recommendations for the use of adjunctive dexamethasone therapy in adults with suspected or proven pneumococcal meningitis.