Central Nervous System

Benzylpenicillin IV

Plus

Gentamicin IV

For true penicillin allergy - seek Microbiology advice

Obtain travel history and consider addingVancomycin IVif

• recently overseas OR
• prolonged or multiple antibiotic exposure within last 3 months

Duration: 14 days if pathogen unknown

Cefotaxime IV

Cefotaxime IV

Obtain travel history and consider adding Vancomycin IV if

• recently overseas OR
• prolonged or multiple antibiotic exposure within last 3 months

Duration:

• If pathogen unknown, 10 days minimum
• Pneumococcal meningitis, 14 days (or longer, up to 21 days, if there are suppurative complications or cerebritis)
• Meningococcal meningitis, minimum 7 days
• Haemophilus meningitis, minimum 10 days

Benzylpenicillin IV

Plus

Gentamicin IV

Duration: 14 days minimum

Cefotaxime IV

Duration: 21 days minimum

Amoxicillin IV

Plus

Gentamicin IV

For true penicillin allergy- seek Microbiology advice

Duration: 21 days minimum (Consider stopping gentamicin after 7 days)

Please refer to meningitis research foundation guidance for diagnosis and management of meningitis in the hospital setting available here:

https://www.meningitis.org/healthcare-professionals/resources

Once a clinical diagnosis of meningitis is made, please report to the Health Protection Team

For meningococcal meningitis, please discuss prophylaxis with the Health Protection Team

If poor clinical response after 48 hours, consider repeat lumbar puncture

Aciclovir IV

Duration: Minimum 21 days

Dose as per local protocol

Ensure adequate hydration (urine output should be at least 1ml / kg / hr)

Recheck CSF prior to completion of therapy. If PCR remains positive, a further 7 days of treatment is indicated