ALL suspected cases of meningitis MUST be discussed with Consultant Microbiologist at first opportunity(during working hours)and reported to Public Health England. Meningococcal sepsis and H influenzae require prophylaxis of contacts
Microbiological specimens
- CSF
- Blood culture
- Throat swab for meningococci
- Urine for pneumococcal antigen
- EDTA blood for meningococci PCR
Serology viruses / cryptococcus [HIV / Immunocompromised] as appropriate
The choice of agent should take into account the patient’s risk for C. difficile infection
Meningococcal meningitis suspected and accompanied with purpuric non-blanching rash or signs of meningitis
Common Pathogen(s)
Streptococcus pneumoniae;
Neisseria meningitides;
Haemophilus influenzae;
Listeria monocytogenes.
Antibiotic – 1st line or Co-trimoxazole 1.44g IV 12 hourly if high risk for Listeria as above |
2nd Line Or chloramphenicol may be used if history of immediate hypersensitivity reaction to penicillin or cephalosporins. Choramphenicol IV 25mg/kg q6h (providing high doses reduced as clinically indicated) (plasma concentration monitoring required in elderly and hepatic impairment) Add in: |
Comment
Notifiable disease
Duration of therapy 7 days
Common Pathogen(s)
Meningococci
Antibiotic – 1st line |
2nd Line |
Duration of therapy 14 days
Common Pathogen(s)
Pneumococci
Antibiotic – 1st line |
2nd Line |
Comment
Dexamethasone 10mg q6h PO for 4 days started with first dose of antibiotics.
Duration of therapy 10 days
Common Pathogen(s)
Haemophilus influenzae.
Antibiotic – 1st line |
Comment
Dexamethasone 10mg q6h PO for 4 days started with or just before the first dose of antibiotics
Duration of therapy 21 days
Common Pathogen(s)
Listeria.
Antibiotic – 1st line Amoxicillin 2g q4h IV 5mg/kg IV q24h (max 500mg): if <70 years and CrCl≥30mL/min or If patient is obese ie. 20% over ideal body weight – use adjusted body weight |
2nd Line |
Comment
Consider this as a possible cause if history of alcohol abuse
Discuss duration of therapy with Neurosurgery/Microbiology during work hours
Common Pathogen(s)
Antibiotic – 1st line |
Comment
Refer to Neurosurgery.
Duration of therapy: 14-21 days, guided by clinical response
Common Pathogen(s)
Herpes simplex;
Varicella zoster.
Antibiotic – 1st line |
Comment
If Herpes simplex positive cases:
If treating for 14days only – repeat lumbar puncture around day 14 and if PCR negative – can stop treatment or if PCR positive – continue for another 14days
Or treat for 21days and no further lumbar puncture is required.
* To avoid excessive dosage in obese patients parenteral dose should be calculated on the basis of ideal weight for height.