SynthesisBMC infectious diseases2026
Early vs. delayed empiric antimicrobial treatment for suspected acute meningitis - a systematic review and meta-analysis.
Synthesis in BMC infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
2 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Early vs. delayed empiric antimicrobial treatment for suspected acute meningitis - a systematic review and meta-analysis.BMC infectious diseases · 2026Pooled it
- Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundAcute bacterial meningitis (ABM) is a life-threatening condition requiring prompt antibiotic administration to reduce mortality and neurological sequelae. The optimal timing of empiric antimicrobial therapy remains uncertain due to limited evidence.
methodsWe conducted a systematic review following Cochrane MECIR standards. The search was carried out on the 2nd of January 2024, including studies from 1946 to January 2024. We included randomized controlled trials and prospective cohort studies with comparator arms. Two reviewers independently screened studies, extracted data, and assessed risk of bias using the ROBINS-I tool. Meta-analyses were performed using RevMan Web, and certainty of evidence was evaluated with the GRADE approach.
resultsThree prospective cohort studies met the inclusion criteria. Very low-certainty evidence from 3 studies with 601 participants revealed an uncertain effect of early empiric antimicrobial treatment on all-cause mortality (RR 0.41, 95% CI 0.26–0.65; I²=44.9%). In addition, very low-certainty evidence from one study with 281 participants indicated an uncertain impact of pre-hospital admission i.e., early antibiotic therapy on development of neurological sequelae, including hearing loss (RR 2.98, 95% CI 1.09–8.13) and paresis (RR 2.21, 95% CI 0.93–5.25). This study also revealed an uncertain effect on CSF (RR 0.95, 95% CI 0.90–1.01) and blood culture positivity rates (RR 0.90, 95% CI 0.80–1.01). Very low-certainty evidence from another study with 148 participants revealed an uncertain impact of early antibiotic therapy (≤ 3 h) on adverse events (RR 0.70, 95% CI 0.53–0.92).
conclusionThe effect of early versus delayed empiric antimicrobial treatment for suspected ABM on mortality, neurological sequelae, and CSF and blood culture positivity rates is uncertain due to very low-certainty evidence. Further high-quality studies are needed to guide clinical practice.
trial registrationPROSPERO registration, CRD42024531465.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.