WHO Launches First-Ever Global Guidelines for Meningitis Diagnosis, Treatment, Care; Check out Major Recommendations

In a significant public health milestone, the World Health Organization (WHO) has issued its first global guidelines for the diagnosis, treatment, and care of meningitis, with a focus on timely detection, optimal treatment, and long-term rehabilitation support. These guidelines aim to help countries reduce deaths and disabilities caused by this life-threatening disease, especially in low- and middle-income countries (LMICs).

Despite advances in vaccination and treatment, bacterial meningitis continues to claim lives and cause long-term disabilities. In 2019 alone, the disease accounted for an estimated 2.5 million cases and 236,000 deaths globally. Around 20% of survivors develop complications such as hearing loss, seizures, and cognitive impairments.

“These new guidelines will save lives and help survivors receive the long-term care they need,” said WHO Director-General Dr. Tedros Adhanom Ghebreyesus

Key Recommendations from WHO Guidelines (2025)

The guidelines are structured into three main areas: Diagnosis, Treatment, and Long-Term Care. Each recommendation includes the strength (strong/conditional/good practice statement) based on WHO GRADE methodology.

A. Diagnosis

1. Lumbar puncture should be done early in suspected cases unless contraindicated. (Good Practice Statement)

2. Perform CSF Gram stain. (Strong recommendation, moderate certainty)

3. Measure CSF white cell count, protein, glucose, and CSF-to-blood glucose ratio. (Strong recommendation, moderate certainty)

4. Consider CSF lactate testing if antibiotics haven’t yet been started. (Conditional recommendation, moderate certainty)

5. Perform CSF culture and antimicrobial susceptibility testing. (Good Practice Statement)

6. Use PCR-based molecular testing on CSF for relevant pathogens. (Strong recommendation, low certainty)

7. Obtain blood cultures before starting antibiotics. (Good Practice Statement)

8. Consider peripheral WBC count, CRP or procalcitonin if available. (Conditional recommendation, low to moderate certainty)

9. Do not perform cranial imaging routinely. (Strong recommendation against, very low certainty)

10. Perform cranial imaging prior to LP if patient presents with red flags (e.g., coma, focal deficits, papilloedema). (Strong recommendation, very low certainty)

11. Defer LP in such cases if imaging isn’t available. (Strong recommendation against, very low certainty)

12. Start treatment without delay-even if LP or imaging is deferred. (Strong recommendation, very low certainty)

B. Treatment

1. Immediately admit or transfer patients with suspected meningitis. (Good Practice Statement)

2. Consider empiric IV/IM antibiotics before transfer if delay is expected. (Conditional recommendation, very low certainty)

3. Administer IV empiric antibiotics ASAP on admission. (Strong recommendation, very low certainty)

4. Use ceftriaxone or cefotaxime as empiric therapy. (Strong recommendation, very low certainty)

5. Add ampicillin or amoxicillin if Listeria risk factors are present (e.g., age >60, immunocompromised). (Strong recommendation, very low certainty)

6. Add vancomycin in areas with cephalosporin-resistant S. pneumoniae. (Conditional recommendation, very low certainty)

7. Use chloramphenicol + penicillin/ampicillin/amoxicillin only if cephalosporins are unavailable. (Conditional recommendation, very low certainty)

8. In non-epidemic settings, discontinue empiric antibiotics after 7 days if patient has recovered and pathogen not identified. (Conditional recommendation, very low certainty)

9. In meningococcal epidemics, treat with ceftriaxone for 5 days. (Strong recommendation, very low certainty)

10. In pneumococcal epidemics, consider ceftriaxone for 10 days. (Conditional recommendation, very low certainty)

11. Provide post-exposure prophylaxis to close contacts with ceftriaxone or ciprofloxacin.

  – Sporadic cases (Strong recommendation, very low certainty)

  – Epidemics (Strong recommendation, very low certainty)

12. Use rifampicin if other prophylactic options unavailable. (Conditional recommendation, very low certainty)

C. Adjunctive Therapies and Supportive Care

1. Start corticosteroids (e.g., dexamethasone) with first dose of antibiotics in non-epidemic settings. (Strong recommendation, low certainty)

2. May start corticosteroids even without LP if strongly suspected bacterial meningitis and no contraindication. (Conditional recommendation, very low certainty)

3. Avoid corticosteroids during meningococcal epidemics. (Strong recommendation against, very low certainty)

4. Use corticosteroids in pneumococcal epidemics. (Strong recommendation, very low certainty)

5. Do not use glycerol as routine adjunct. (Conditional recommendation against, low certainty)

6. Do not routinely restrict fluids. (Conditional recommendation against, very low certainty)

7. Use anti-seizure medicines short-term (≤3 months) for acute seizures. (Conditional recommendation, very low certainty)

D. Long-Term Management of Sequelae

1. Assess for neurological sequelae before discharge and at 4-week follow-up. (Strong recommendation, very low certainty)

2. Start early rehabilitation for patients with disabilities. (Strong recommendation, very low certainty)

3. Conduct audiological screening before or within 4 weeks of discharge. (Strong recommendation, very low certainty)

4. Provide early hearing rehabilitation if loss is detected. (Strong recommendation, very low certainty)