Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management—summary of updated NICE guidance

### What you need to know Bacterial meningitis and meningococcal disease are uncommon but life-threatening conditions. Early recognition is important but difficult because of the non-specific ways in which individuals present. The National Institute for Health and Care Excellence (NICE) initially published guidance on the conditions in 2010 and, after a surveillance review in 2018, updated it following changes in guideline development methodology and to reflect recent developments in vaccination.1 The 2024 guidance also extends the population of the original guideline from children only to including recommendations for adults.1 The term “bacterial meningitis” includes meningococcal meningitis without meningococcal sepsis and meningitis caused by other bacteria, while the term “meningococcal disease” includes meningococcal sepsis with or without meningococcal meningitis. Evidence for the two conditions was reviewed separately but considered in parallel. Whether separate recommendations were needed for each condition was decided based on the evidence and Guideline Committee’s experience. In this article, we summarise selected recommendations related to early recognition of these conditions, timing of investigations, initiating antibiotic therapy, and follow-up. NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Committee’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. ### GRADE Working Group grades of evidence