Bacterial Meningitis

Important: Therapy

Treatment should not be delayed in suspected cases of bacterial meningitis.

Immediate antimicrobial therapy should be given, prior to lumbar puncture if there is any delay.

See British Infection Association Meningitis and Encephalitis Quick Reference Guide

Contact Health Protection Team for advice about contacts

• Send CSF, blood for culture and glucose testing, nose and throat swabs and swab for gram-stain from any purpuric lesions but this should not delay treatment in cases of meningitis.
• Send an EDTA blood for Polymerase Chain Reaction (PCR).
• Specialist advice from medical microbiology is essential.
• Amend antibiotics on the basis of microbiology results.
• If recurrent - consider immune deficiency and testing for HIV.

Notes:

Important: Therapy

IV Ceftriaxone 2g 12 hourly

If risk of Listeria age: ≥ 60 years, pregnancy or immunocompromised (including alcohol dependency, diabetes and malignancy)

Add IV Amoxicillin 2g 4 hourly to cover Listeria.

(Or if penicillin allergy, IV Co-trimoxazole 120mg/kg/day divided into 4 doses/day)

Give IV Dexamethasone base 10mg 6 hourly.

Notes:

• Rationalise antibiotics after discussion with Infection Specialist.
• Confirm dexamethasone duration with Infection Specialist.

Important: Therapy

IV Chloramphenicol 25 mg/kg 6 hourly

If risk of Listeria age: ≥ 60 years, pregnancy or immunocompromised (including alcohol dependency, diabetes and malignancy)

Switch to IV Meropenem 2g 8 hourly, if no carbapenem allergy.

Give IV Dexamethasone base 10mg 6 hourly.

Notes:

• For guidance on assessing a patient’s history of penicillin allergy, refer to Penicillin Allergy poster.
• For further details on prescribing chloramphenicol, refer to SAPG Guidance.
• Rationalise antibiotics after discussion with Infection Specialist.
• Confirm dexamethasone duration with Infection Specialist.