Clinical signs suggestive of meningitis such as Kernig’s sign have low sensitivity in adults and fever, headache, neck stiffness, and altered mental status are the common clinical manifestations. Where possible, a sample of cerebrospinal fluid (CSF) should be taken and a combination of a third-generation cephalosporin and vancomycin started as empiric treatment. Amoxicillin should be added in the elderly or others at risk of listeriosis. Corticosteroids administered with antibiotics may reduce mortality from meningitis due to Streptococcus pneumoniae and severe hearing loss in children due to Haemophilus influenzae. Those over 65 years of age and patients in other risk groups should be vaccinated against invasive pneumococcal disease. Increasingly, there are recommendations that both the polysaccharide vaccine (PPV23) and conjugated vaccines (e.g. PCV13) should be used to maximize protection.