In suspected bacterial meningitis, what is the recommended sequence of steps?

• A. Draw blood cultures, perform lumbar puncture when safe, then start IV antibiotics
• B. Draw blood cultures, start IV antibiotics, perform lumbar puncture when safe
• C. Start IV antibiotics before obtaining blood cultures
• D. Perform lumbar puncture first, before antibiotics

Answer: (B)

In suspected bacterial meningitis, time to treatment matters most. The best sequence is to draw blood cultures first to maximize the chance of identifying the organism, then start empiric IV antibiotics immediately to reduce mortality and morbidity. Perform a lumbar puncture after those steps, once it is safe to do so. This approach ensures you don’t delay life-saving therapy for diagnostic procedures, while still obtaining essential information from blood cultures and CSF when feasible. Delaying antibiotics for an LP or skipping blood cultures before starting therapy can worsen outcomes and diminish diagnostic yield.