The evaluation of meningitis includes blood cultures

The evaluation of meningitis includes blood cultures, head imaging, and lumbar puncture in a hemodynamically stable patient. A head CT should be obtained to rule out an intracranial mass in patients with signs of increased intracranial pressure (vomiting, papilledema, altered mental status). A negative head CT should prompt subsequent blood cultures and a lumbar puncture before initiating antibiotics. In an unstable patient suspected to have bacterial meningitis, antibiotics should be initiated before blood cultures or a lumbar puncture is obtained. Empiric treatment of bacterial meningitis depends on the risk factors for specific pathogens. An immunocompetent adult patient with no other risk factors such as this patient can be started on vancomycin and a third-generation cephalosporin.