Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management

Why the committee made the recommendations

Bacterial meningitis and meningococcal disease can be fatal if treatment is delayed. They are also difficult to diagnose, as they can present with non-specific symptoms and signs, and can be difficult to distinguish from other infections. The committee used their expertise and the available evidence to highlight the most important risk factors and specific and non-specific symptoms and signs to take into account when considering a diagnosis, to help reduce the chance that bacterial meningitis and meningococcal disease are missed.

How the recommendations might affect practice

The recommendations are in line with current practice and they should not have a significant resource impact. The recommendations will help healthcare professionals recognise and diagnose bacterial meningitis and meningococcal disease earlier, and earlier treatment will lead to reduced costs.

Return to recommendations

Why the committee made the recommendations

There was evidence on the sensitivity and specificity of the following symptoms, for a diagnosis of bacterial meningitis:

In the committee's experience, people with all of these symptoms and signs together are highly likely to have bacterial meningitis. However, the committee emphasised that bacterial meningitis should not be ruled out just because a person does not have one or more of these signs or symptoms. Bacterial meningitis can present in different ways, particularly in babies and older adults or if people are presenting early in the condition.

The other symptoms and signs listed are based on the evidence and the committee's knowledge and experience. Outside of the red flag combination, the evidence was not clear enough for the committee to rank the symptoms and signs in order of importance. However, in the committee's experience, the more symptoms and signs present, the more likely it is that the person has bacterial meningitis.

The evidence on risk factors was limited, because it came from a single study looking at perinatal risk factors (such as low birth weight) for bacterial meningitis. In the absence of evidence, the committee specified risk factors based on their knowledge and experience. Some of the risk factors are also indirect indicators of potential immune deficiency (including family history and a previous episode of meningitis or meningococcal disease).

How the recommendations might affect practice

The recommendations are in line with current practice and they should not have a significant resource impact. The recommendations will help healthcare professionals recognise and diagnose bacterial meningitis earlier. This will allow for earlier treatment, which will reduce costs through lower rates of death and complications.

Return to recommendations

Why the committee made the recommendations

Evidence showed that these symptoms both had at least moderate sensitivity and specificity for a diagnosis of meningococcal disease:

There was also evidence that some symptoms and signs of meningitis (including neck pain or stiffness, photophobia, and a composite clinical factor of signs or symptoms of meningism) were also moderately or highly specific for a diagnosis of meningococcal disease. In the committee's experience, when a person has symptoms and signs that could indicate meningitis or meningococcal disease, they are more likely to have meningococcal disease if they also have a non-blanching petechial or purpuric rash.

While a non-blanching petechial or purpuric rash is a commonly known sign of meningococcal disease (and this is supported by the evidence), the committee were aware based on their knowledge and experience that not everyone with meningococcal disease will have a rash. They highlighted this issue to avoid people being misdiagnosed and to avoid delays to treatment.

The committee gave advice on finding rashes, because in their experience, not all healthcare professionals are aware of these issues.

The other symptoms and signs listed are based on the evidence and the committee's knowledge and experience. Outside of the red flag symptoms, the evidence was not clear enough for the committee to rank the symptoms and signs in order of importance.

The risk factors listed are based on evidence and the committee's knowledge and experience. Some of the risk factors are also indirect indicators of potential immune deficiency (including family history and a previous episode of meningitis or meningococcal disease).

How the recommendations might affect practice

The recommendations are in line with current practice and they should not have a significant resource impact. The recommendations will help healthcare professionals recognise and diagnose meningococcal disease earlier. This will allow for earlier treatment, which will reduce costs through lower rates of death and complications.

Return to recommendations

Why the committee made the recommendations

Because bacterial meningitis and meningococcal disease are difficult to diagnose or distinguish from other conditions, the committee agreed that it is important to provide safety netting. Based on their knowledge and experience, they made recommendations to cover people who are unlikely to have bacterial meningitis or meningococcal disease, but who need monitoring for changes to symptoms. They also highlighted other serious conditions with similar symptoms and signs.

How the recommendations might affect practice

The recommendations are in line with current practice and they should not have a significant resource impact.

There will be a level of uncertainty even in people who are unlikely to have bacterial meningitis or meningococcal disease. Safety netting helps mitigate the potential harms and costs of missed infections, and harms and costs from other serious conditions with similar symptoms and signs.

Return to recommendations

Why the committee made the recommendations

Delay to treatment for bacterial meningitis or meningococcal disease can be fatal, or cause serious complications. Because of this, the committee agreed (based on their knowledge and experience) that people with suspected or strongly suspected bacterial meningitis or meningococcal disease should be transferred to hospital as an emergency.

For suspected bacterial meningitis, there is evidence showing no clear benefit from pre-hospital antibiotics (in terms of all-cause mortality, long-term neurological impairment, or functional impairment). Giving antibiotics before transfer to hospital would also affect the results of cerebrospinal fluid tests and some blood tests. In line with this evidence, the committee agreed that antibiotics should not normally be given outside of hospital, unless there is a clinically significant delay in transfer to hospital and bacterial meningitis is strongly suspected. The committee could not give a timeframe for what delay counts as clinically significant, because there was no evidence on this point.

Similarly, evidence for meningococcal disease did not show clear benefits from pre-hospital antibiotics, and giving antibiotics before hospital would also affect blood test results. However, given the rapid progression and seriousness of meningococcal disease, the committee agreed that pre-hospital antibiotics should be given as soon as possible when the disease is strongly suspected.

While the committee recommended antibiotics outside of hospital in some circumstances, they highlighted that the priority for both bacterial meningitis and meningococcal disease should be the transfer to hospital. This is so that urgent testing can be done to get a clear diagnosis and start the correct treatment as soon as possible.

When antibiotics need to be given outside of hospital, ceftriaxone is the preferred option because it is a more active agent. However, it is less commonly available outside of hospital. Therefore, benzylpenicillin is also recommended because it is commonly available and practical to use outside of hospital.

How the recommendations might affect practice

The recommendations are in line with current practice. Benzylpenicillin is commonly available outside of hospital. Ceftriaxone use is rarer outside of hospital, but it may be available in some settings.

Return to recommendations

Why the committee made the recommendations

The recommendations on what to discuss with people with suspected bacterial meningitis or meningococcal disease are based on evidence and the committee's knowledge of:

There was evidence on accessible, person-centred communication and sharing information. However, this is covered by existing recommendations in the NICE guidelines on patient experience in the NHS.

This guideline also makes recommendations on information and support after diagnosis.

How the recommendations might affect practice

The recommendations are good practice, although they are not currently implemented everywhere. The list of issues to discuss is short and should not take up much time, as the focus at this stage is diagnosis and treatment.

Return to recommendations

Why the committee made the recommendation

As suspected bacterial meningitis is a medical emergency, the committee agreed (based on their knowledge and experience) that a senior clinical decision maker should perform an initial assessment and ensure that investigations are done promptly. This will prevent unnecessary delays to the first dose of antibiotics (if this was not given before arrival at hospital).

How the recommendation might affect practice

Hospitals may need to streamline their processes so that blood tests can be done within the 1-hour timeframe for giving antibiotics.

Return to recommendation

Why the committee made the recommendations

A bacterial throat swab can provide information about the strain of Neisseria meningitidis. The Public Health England guidance on managing meningococcal disease recommends taking a bacterial throat swab for suspected meningococcal disease to provide information about the infecting strain, to guide management of cases, contacts and outbreaks. The committee extended this to people with suspected bacterial meningitis because Neisseria meningitidis is a potential cause of meningitis.

All of the evidence was based on individual blood tests and the committee agreed that none of these blood tests alone would be sufficient to make a diagnosis of bacterial meningitis, nor should any of these tests be used to rule out bacterial meningitis. However, blood tests are an important tool for gathering information to inform the diagnosis, when used alongside clinical features and lumbar puncture results. The recommended blood tests are all simple, relatively cheap, and widely used in current practice.

Both C-reactive protein (CRP) and procalcitonin (PCT) were shown to be useful tests for bacterial meningitis. However, PCT is only recommended if CRP is not available, because PCT is more expensive and the evidence did not demonstrate a large difference in diagnostic accuracy.

How the recommendations might affect practice

Bacterial throat swab, CRP, PCT, white cell count, blood culture, and polymerase chain reaction (PCR) are routinely used in current practice. Hospitals may need to streamline their processes so that blood tests can be done within the 1‑hour timeframe for giving antibiotics.

Return to recommendations

Why the committee made the recommendations

Evidence showed that performing a lumbar puncture without waiting for a CT scan led to people receiving antibiotic treatment sooner. This may reduce the rates of:

While most people with suspected meningitis do not need imaging before a lumbar puncture, neuroimaging should be performed for people with risk factors for an evolving space occupying lesion. Imaging should also be performed for people with the following features of raised intracranial pressure, due to the risk of brain herniation following lumbar puncture:

Based on their knowledge and experience, the committee defined the change in consciousness that would indicate neuroimaging was needed. They also highlighted that antibiotics should be given and bloods taken before imaging, since it can take time for neuroimaging to be completed.

How the recommendations might affect practice

These recommendations will result in less neuroimaging being performed.

Return to recommendations

Why the committee made the recommendations

Lumbar puncture is the only test that can directly confirm a diagnosis of bacterial meningitis.

Antibiotics can affect the results of cerebrospinal fluid tests, so lumbar puncture needs to be performed before antibiotics when possible. The committee did not recommend a specific timeframe for performing lumbar puncture because they were concerned that it would be interpreted as a hard cutoff. The key timeframe is the 1‑hour timeframe for giving antibiotics, but clinical judgement is needed for decisions on how to fit lumbar puncture around this. For example, for some people, it may be safe to delay the antibiotics by slightly longer than 1 hour, if this would allow a lumbar puncture to be performed first.

The committee used their experience to highlight situations that need treating or stabilising before a lumbar puncture, because these are potentially life-threatening and present a greater risk than delayed meningitis investigations.

How the recommendations might affect practice

Lumbar punctures can often be performed more quickly on acute medical wards than in emergency departments. Because of this, hospitals may need to be able to urgently transfer people with suspected bacterial meningitis out of emergency departments (following stabilisation). Hospitals may also need to streamline their processes so that acute medical wards can perform lumbar punctures within the 1‑hour timeframe for giving antibiotics.

Return to recommendation 1.4.2

Return to recommendations 1.4.9 to 1.4.13

Why the committee made the recommendations

There was evidence on various cerebrospinal fluid investigations for diagnosing bacterial meningitis:

The committee highlighted that cerebrospinal fluid cell counts, total protein and glucose concentrations are important for clinical decision making and to guide antibiotic treatment, and agreed that these results should be available within 4 hours.

It is important to look at the whole clinical picture and take a full clinical history, including maternal history for babies aged 28 days or under. This is because there are factors that may reduce the reliability of cerebrospinal fluid investigations. Based on their knowledge and experience the committee highlighted the most important of these factors.

Age-appropriate threshold values for cerebrospinal fluid should be used.

The committee highlighted the need to consider alternative diagnoses because there could be serious consequences if a potentially treatable alternative cause is missed.

There are new diagnostic techniques currently in development, such as host biomarker or metagenomic techniques. These may be able to address some of the problems with the current gold standards for diagnosing bacterial meningitis, including the time taken to receive results, the need to start antibiotic treatment before confirming a diagnosis, and the difficulties with differential diagnoses. As these techniques have not yet been sufficiently validated for clinical use, the committee made a recommendation for further research on novel diagnostics.

How the recommendations might affect practice

The recommendations largely support current practice, and they should not have a significant resource impact.

PCR was not included as part of cerebrospinal fluid investigations in the 2010 guideline, but it has since become standard practice in most hospitals.

Return to recommendations

Why the committee made the recommendations

As suspected meningococcal disease is a medical emergency, the committee agreed (based on their knowledge and experience) that a senior clinical decision maker should perform an initial assessment and ensure that investigations are done promptly. This will prevent unnecessary delays to the first dose of antibiotics (if this was not given before arrival at hospital).

A bacterial throat swab can provide information about the strain of Neisseria meningitidis. The Public Health England guidance on managing meningococcal disease recommends taking a bacterial throat swab for suspected meningococcal disease to provide information about the infecting strain, to guide management of cases, contacts and outbreaks.

Blood tests (along with clinical features) are the main way to diagnose meningococcal disease. The recommended tests are also all simple, relatively cheap, and widely used in current practice.

PCT is only recommended if CRP is not available. This is because it is more expensive and the evidence did not demonstrate a large difference in diagnostic accuracy.

It is important not to make a diagnosis on the basis of an individual blood test or to rule out meningococcal disease based on a normal CRP, PCT or white blood cell count alone, because none of these tests were shown to be both very sensitive and very specific.

The evidence for the diagnostic accuracy of blood culture or whole-blood diagnostic PCR were not reviewed, because these tests were used as reference standards.

How the recommendations might affect practice

CRP, PCT, white cell count, lactate, blood culture, and PCR are routinely used in current practice. Hospitals may need to streamline their processes so that blood tests can be done within the 1-hour timeframe for giving antibiotics.

Return to recommendations

Why the committee made the recommendations

For adults in hospital, there was evidence that giving antibiotics as soon as bacterial meningitis is suspected reduces mortality, compared with giving antibiotics later. The evidence also showed that giving antibiotics early reduced functional impairment, but only when compared against delays of longer than 6 hours.

For babies, children, or young people, there was no evidence that met the review criteria. The committee agreed, based on the evidence for adults as well as their clinical knowledge and expertise, that there were similar risks of adverse outcomes for these groups if antibiotics were delayed.

The 1-hour timeframe for starting antibiotics in hospital is based on the committee's expertise, and on the well-recognised principle of the 'golden hour' for optimal treatment of life-threatening emergencies such as meningitis. Blood tests and lumbar puncture should also be completed within this hour (when it is safe and practical to do so), so that samples can be taken before antibiotics are started in hospital.

The committee recommended getting infection specialist advice for bacterial meningitis, because there may be concerns about antibiotic resistance or uncertainty about treatment in specific people (for example, because of comorbidities). This is particularly important for suspected or confirmed cephalosporin-resistant bacterial meningitis, because alternative antibiotics may be needed and there is no evidence for specific antibiotics in this situation.

The evidence on specific antibiotics was very limited (low or very low quality evidence, with small numbers of participants). The committee recommended intravenous ceftriaxone based on their knowledge and experience. Ceftriaxone is a broad-spectrum antibiotic that can be used to treat the most common infective organisms. This treatment is in line with current practice and the BNF and BNFC. There are also potential practical and cost benefits with ceftriaxone, as it can be given once a day. Cefotaxime is recommended as an alternative because ceftriaxone is contraindicated in some circumstances for premature babies. This recommendation is also in line with the BNFC.

There was no evidence on the effectiveness of antibiotics for Listeria monocytogenes that met the review criteria. Based on the committee's clinical knowledge and experience, listeria is not susceptible to ceftriaxone or cefotaxime. The committee recommended amoxicillin for people with risk factors for listeria, because amoxicillin is recommended by the BNF and the BNFC. In the committee's experience, co-trimoxazole can also be beneficial, particularly with bacteraemic or septic illness. However, the committee recommended getting infection specialist advice before using co-trimoxazole, because of the associated risks and monitoring requirements.

The committee were concerned about the overuse of aciclovir. In their experience it is frequently prescribed for suspected meningitis, but it is only beneficial for herpes simplex encephalitis. The committee agreed that aciclovir should only be given when herpes simplex encephalitis is strongly suspected.

The evidence showed no difference between short and long courses of ceftriaxone for bacterial meningitis (4 days compared with 10 days, 7 days compared with 10 days, and 4 to 7 days compared with 8 to 14 days). Given this evidence, the committee recommended short courses of antibiotics.

In the committee's experience, the results of confirmatory tests could be available within 2 to 3 days. It is current practice to continue empirical antibiotic treatment until the causative organism is identified or an alternative diagnosis is confirmed.

The committee highlighted that the UK Health Security Agency should be notified of any suspected cases of meningococcal meningitis or other meningococcal disease.

How the recommendations might affect practice

The guideline recommends shorter courses of antibiotics than the courses used in current practice.

Hospitals may need to streamline their processes so that blood tests and lumbar puncture can be done within the 1-hour timeframe for giving antibiotics.

Return to recommendations

Why the committee made the recommendations

Given the limitations of the evidence (for example, very low quality evidence and small numbers of participants), the committee recommended intravenous ceftriaxone for most causative organisms, based on their knowledge and experience. Ceftriaxone is a broad-spectrum antibiotic that can be used to treat the most common infective organisms. This treatment is in line with current practice and the BNF and the BNFC. There are also practical and cost benefits with ceftriaxone, as it only needs to be given once a day. Cefotaxime is recommended as an alternative because ceftriaxone is contraindicated in some circumstances. This recommendation is also in line with the BNFC.

On treatment length, the evidence showed no difference between short and long courses of ceftriaxone for Haemophilus influenzae type b meningitis or meningococcal meningitis (5 days compared with 10 days). For other organisms, there was no evidence that met the review criteria. Given the limitations of the evidence, the committee recommended treatment lengths based on their knowledge, experience and on current practice.

There was no evidence on the effectiveness of antibiotics for Listeria monocytogenes that met the review criteria. The committee recommended amoxicillin or ampicillin because these were recommended in the 2010 guideline (based on the knowledge and experience of the 2010 committee). In the 2024 committee's experience, co-trimoxazole can also be beneficial, particularly with bacteraemic or septic illness. However, the committee recommended getting infection specialist advice before using co-trimoxazole, because of the associated risks and monitoring requirements.

Standard treatment duration for meningitis caused by Enterobacterales (coliforms) is at least 21 days. However, this is not evidence-based and may be based on the principle of providing 14 days of antibiotics after sterilisation of cerebrospinal fluid. As third-generation cephalosporins are associated with more rapid sterilisation, the committee made a recommendation for research on the effectiveness of shorter courses of antibiotics for meningitis caused by Enterobacterales (coliforms).

How the recommendations might affect practice

The recommendations are in line with current practice.

Return to recommendations

Why the committee made the recommendation

There was no evidence specific to meningitis on antibiotics for people with an antibiotic allergy, so the committee made recommendations based on their knowledge and experience.

Ceftriaxone is still recommended for non-severe allergies because cephalosporin-induced anaphylaxis is rare.

For people with risk factors for Listeria monocytogenes and a non-severe allergy, the committee recommended co-trimoxazole in addition to ceftriaxone or cefotaxime, because this is in line with current practice. (Risk factors for Listeria monocytogenes include being very old or very young, pregnancy, cancer, kidney disease, liver disease, diabetes, alcohol misuse, and taking drugs that suppress the immune system.)

For people with a severe allergic reaction, the committee recommended chloramphenicol for most causative organisms or when the cause is unknown, because this is in line with current practice. They specified co-trimoxazole and chloramphenicol for people with risk factors for Listeria monocytogenes because this is in line with current practice and the BNF.

How the recommendation might affect practice

The recommendations are in line with current practice, and they should not have a significant resource impact.

Return to recommendation

Why the committee made the recommendations

Ceftriaxone is recommended for meningococcal disease because:

On duration of antibiotics, there was no evidence that met the review criteria. The committee recommended treatment lengths based on their knowledge, experience and on current practice.

For antibiotic allergy, there was no evidence that met the review criteria, so the committee made recommendations based on their knowledge and experience. Ceftriaxone is still recommended for non-severe allergies because cephalosporin-induced anaphylaxis is rare, and when compared with chloramphenicol the balance of risks and benefits for ceftriaxone is favourable in most people with non-severe allergy. For people with a severe allergic reaction, the committee recommended chloramphenicol because this is in line with current practice.

How the recommendations might affect practice

The recommendations are in line with current practice.

Return to recommendations

Why the committee made the recommendations

How the recommendations might affect practice

Why the committee made the recommendations

How the recommendations might affect practice

Why the committee made the recommendations

The committee had concerns about the reliability of the evidence, because the sample sizes were not large enough to detect rare events and because people with known immunodeficiency will often receive interventions to prevent recurrent infections. Because of this, the committee used their knowledge and expertise to make recommendations.

The committee agreed that:

Based on this, the committee recommended HIV testing for adults. Many risk factors for HIV are less likely to be relevant to babies, children and young people, so they do not need to be routinely tested unless there are signs of immunodeficiency and other risk factors.

The committee agreed that referral to specialists was needed for babies, children and young people with pneumococcal meningitis, because this disease may indicate a lack of immune response to pneumococcal vaccination and may be associated with primary immune deficiencies. Adults were not included in this recommendation because there was no evidence of increased rates of primary immunodeficiency in adults with invasive pneumococcal disease.

Some anatomical factors increase the risk of bacterial meningitis (see the explanation of the recommendations on risk factors in the rationale section on when to suspect bacterial meningitis). The committee agreed that people should be checked for these factors (including signs of a sinus tract), to assess whether they may need intervention to prevent future episodes.

How the recommendations might affect practice

Testing for HIV in adults with a serious infection is in line with current practice. Testing for babies, children and young people is not, but the group who need testing is likely to be small so the resource impact will be minimal.

Other recommendations are in line with current practice.

Return to recommendations

Why the committee made the recommendations

The committee made recommendations based on evidence on the views of parents and carers, and based on their knowledge and experience. The themes in the evidence were consistent for both bacterial meningitis and for meningococcal disease, so the committee made recommendations that apply to both conditions.

The committee emphasised the need to discuss the issues covered in the recommendations with people with bacterial meningitis or meningococcal disease, to give them the chance to ask questions, and to repeat information over time. This is because people may be distressed and unable to ask questions or understand information when they are first admitted to hospital.

Emotional and pastoral support is recommended because of the severe impact meningitis can have on a person. Likewise, some people will experience prolonged distress and would benefit from psychological interventions.

The committee also wanted to ensure that people knew how to get support after leaving hospital, because they will likely need follow-up assessments and aftercare for weeks or months after discharge.

How the recommendations might affect practice

The recommendations largely reflect current practice and they should not have a significant resource impact.

Return to recommendations

Why the committee made the recommendations

Evidence showed that meningitis and meningococcal disease can result in a range of long-term complications, such as:

Most of the evidence concerned long-term complications for babies, children, young people and young adults. However, the committee agreed that it was reasonable to extrapolate much of this evidence to adults, because meningitis can have similar impacts on people regardless of age.

Based on this evidence, the committee agreed that people with bacterial meningitis or meningococcal disease should not be discharged from hospital until follow-up needs have been identified and planned for, and until certain assessments have been planned or completed. The committee did recognise that certain tests, like an audiological assessment, might not be possible until after discharge (although testing before discharge would be preferable).

The evidence for epilepsy as a long-term complication was mixed. For example, there was evidence of an increase in children who have had meningitis being admitted as inpatients because of epilepsy, but no evidence of increased use of outpatient epilepsy services in the same population. The committee were also concerned about unnecessary long-term use of anti-epileptic drugs. They recommended a 3-month review to check whether the seizures were a short-term effect of the illness.

The evidence on long-term complications after bacterial meningitis in newborn babies was limited to a single, small study. The committee agreed that quantifying the long-term complications of bacterial meningitis is important, to allow follow-up to be arranged for those at risk and to help with prioritising treatment and prevention strategies. To address this, the committee made a recommendation for research to investigate long-term outcomes after bacterial meningitis in infancy.

How the recommendations might affect practice

It is routine practice to identify possible follow-up needs before discharge and to make referrals when needed. There is some variation in follow-up for adults, but this should not have a significant resource impact given the small numbers of people affected.

Return to recommendations

Why the committee made the recommendations

There was evidence on the views and experiences of families and carers of people who have had meningitis. The committee built on this with their own expertise. They recommended coordination with other professionals and services because this will ensure that follow-up care and support meets the person's needs, and will potentially reduce the impact of long-term complications.

Referral for psychosocial support is recommended because of the potential psychological impact of meningitis. It may need to be arranged after discharge because the impact may not be apparent immediately.

How the recommendations might affect practice

It is routine practice to make referrals and plan for care after discharge, and to inform GPs and other key professionals of any follow up needs. There is some variation in follow-up for adults, but this should not have a significant resource impact given the small numbers of people affected.

Return to recommendations

Why the committee made the recommendations

The committee agreed areas to cover in the post-discharge review based on the evidence of the long-term complications associated with meningitis (see the explanation of the recommendations on identifying and managing complications).

The review should happen at 4 to 6 weeks after discharge so that short-term effects of the illness can be ruled out and long-term issues can be identified early enough to make prompt referrals. The results of hearing tests may not be available at this point (for example, if illness interferes with the timing of the test), but the overall review should not be delayed if this is the case.

The evidence showed particular long-term complications for babies, children and young people. The committee used their own knowledge and experience to make recommendations on further tests and reviews for this group. These tests and reviews are important for identifying late-onset complications and developmental issues as children and young people grow up.

The tests and reviews recommended will involve staff working in multiple services, across health and education. The committee made a recommendation on coordinating follow-up, to avoid situations where professionals assume other services are responsible and people do not receive proper care as a result.

The evidence suggested that meningitis can increase the risk of poor educational outcomes, that the impact of long-term complications may not always be apparent, and that children and younger people who are seen to be underachieving could be achieving more if they had more specific support. This guideline does not cover education settings, so the committee advised parents and carers to discuss educational complications with their child or young person's school.

No evidence was identified relating to a phased return to work. However, based on their knowledge and experience the committee recommended that healthcare professionals discuss this with people, so they could plan for their return to work.

How the recommendations might affect practice

It is routine practice to review people who have had meningitis or meningococcal disease for long-term complications after hospital discharge. There is some variation in follow-up for adults, but this should not have a significant resource impact given the small numbers of people affected.

Return to recommendations

Why the committee made the recommendations

How the recommendations might affect practice