The role of lumbar puncture in bacterial meningitis has been debated in recent years, especially in the presence of worsening headache, alteration of conscious level, focal neurological signs, papilloedema or a haemorrhagic rash. However valuable bacteriological and epidemiological information will be lost if lumbar puncture is avoided, despite blood cultures being taken. This loss ofinformation will be highlighted if pre-admission antibiotics are administered (this should now be standard practice).
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