Communicable E30: WHO's first-ever guideline on meningitis

Meningitis remains a major global health threat, with an estimated 2.5 million cases each year; of these, one in six results in death and one in five in long-term disabilities. Although meningitis “can strike anyone, anywhere in the world,” outbreaks disproportionately impact low- and middle-income countries, where diagnostic and treatment resources are limited. In efforts to address this, WHO launched its first-ever guideline on meningitis diagnosis and management in April this year. In this episode of Communicable, hosts Emily McDonald and Marc Bonten are joined by two experts directly involved in creating the guideline, Lorenzo Pezzoli and Nicolò Binello (WHO), as well as Jacob Bodilsen (Aalborg University), clinician-researcher and Chair of ESCMID’s Study Group for Infectious Diseases of the Brain (ESGIB). The guests offer a firsthand look behind the guideline’s development, review key recommendations for diagnosis and treatment - including the use of lumbar puncture, antibiotics, and chemoprophylaxis – and discuss how these fit into various clinical settings. 


This episode was edited by Kathryn Hostettler and peer reviewed by Ljiljana Lukić of University Hospital for Infectious Diseases in Zagreb, Croatia. The executive producer of Communicable is Angela Huttner. 


Terms

• CRP, C-reactive protein
• GDG, Guideline Development Group

Literature 

1. WHO guidelines on meningitis diagnosis, treatment and care. April 2025. https://www.who.int/publications/i/it...
2. Defeating meningitis by 2030: a global road map. June 2021. https://www.who.int/publications/i/it...
3. Olie SE, et al. Validation and clinical implementation of cerebrospinal fluid C-reactive protein for the diagnosis of bacterial meningitis: a prospective diagnostic accuracy study. Lancet Reg June 2025. DOI: 10.1016/j.lanepe.2025.101309 (https://doi.org/10.1016/j.lanepe.2025...)
4. Coldiron ME, et al. Single-dose oral ciprofloxacin prophylaxis as a response to a meningococcal meningitis epidemic in the African meningitis belt: A 3-arm, open-label, cluster-randomized trial. PloS Med 2018. DOI: 10.1371/journal.pmed.1002593 (https://doi.org/10.1371/journal.pmed....)
5. Hasbun R, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med 2001. DOI: 10.1056/NEJMoa010399 (https://doi.org/10.1056/NEJMoa010399)
6. Glimåker M. Lumbar puncture in adult bacterial meningitis: time to reconsider guidelines? BMJ 2013, DOI: 10.1136/bmj.f361 (https://doi.org/10.1136/bmj.f361)