Suspected meningococcal meningitis — emergency OSCE · MBBS OSCE

Candidate instructions

Manage the emergency presentation. Do not delay life-saving treatment for imaging.^[1]

Candidate tasks

ABC and treat shock before any LP.^[1]
Give the first antibiotic within 1 hour (state the sourced adult pre-hospital dose).^[1]^[2]
Explain when CT before LP is needed — after antibiotics if delay.
Consider dexamethasone with the first antibiotic; stop routine steroids if this is meningococcal disease.
Notify public health and prescribe contact prophylaxis.

Examiner checklist

Antibiotics within 1 hour; never delayed for CT/LP
Adult suspected-IMD dose: ceftriaxone 2 g IV/IM stat ^[2]
Dexamethasone 10 mg with or before first antibiotic if bacterial meningitis remains possible; NICE does not routinely continue steroids for meningococcal disease ^[1]^[3]
Do not LP through spreading purpura; bloods, antibiotics, stabilise before imaging ^[1]
Contact ciprofloxacin 500 mg once (12 years and over) ^[2]
Index case already on ceftriaxone does not need carriage eradication ^[2]

Model standard

Resuscitate and give ceftriaxone within 1 hour (UKHSA adult 2 g stat). Investigate in parallel. Do not LP through spreading purpura. Notify. Ciprofloxacin 500 mg once for close contacts aged 12+. Add amoxicillin only if Listeria risk factors are present. Aciclovir only if HSV encephalitis is strongly suspected.^[1]^[2]

Common errors

Delaying antibiotics for CT^[1]
Vancomycin as a NICE default^[1]
Rifampicin-first contacts
LP through purpura
Age-over-50 as a numbered Listeria cutoff

References3Show

[1]National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management NICE guideline NG240, 2024.Source
[2]UK Health Security Agency. Guidance for public health management of meningococcal disease in the UK UKHSA, 2025.Source
[3]de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. New England Journal of Medicine, 2002.PMID 12432041

Candidate tasks

ABC and treat shock before any LP.^[1]

Give the first antibiotic within 1 hour (state the sourced adult pre-hospital dose).^[1]^[2]

Explain when CT before LP is needed — after antibiotics if delay.

Consider dexamethasone with the first antibiotic; stop routine steroids if this is meningococcal disease.

Notify public health and prescribe contact prophylaxis.

Examiner checklist

Antibiotics within 1 hour; never delayed for CT/LP

Adult suspected-IMD dose: ceftriaxone 2 g IV/IM stat ^[2]

Dexamethasone 10 mg with or before first antibiotic if bacterial meningitis remains possible; NICE does not routinely continue steroids for meningococcal disease ^[1]^[3]

Do not LP through spreading purpura; bloods, antibiotics, stabilise before imaging ^[1]

Contact ciprofloxacin 500 mg once (12 years and over) ^[2]

Index case already on ceftriaxone does not need carriage eradication ^[2]

Model standard

Common errors

Delaying antibiotics for CT^[1]

Vancomycin as a NICE default^[1]

Rifampicin-first contacts

LP through purpura

Age-over-50 as a numbered Listeria cutoff

References3Show

[1]National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management NICE guideline NG240, 2024.Source
[2]UK Health Security Agency. Guidance for public health management of meningococcal disease in the UK UKHSA, 2025.Source
[3]de Gans J, van de Beek D. Dexamethasone in adults with bacterial meningitis. New England Journal of Medicine, 2002.PMID 12432041