Bacterial Meningitis

Important: Therapy

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

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

See British Infection Society (BIS) algorithm

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 ethylenediaminetetraacetic acid (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 patient >55 years

add IV Amoxicillin 2g 4 hourly to cover Listeria

(or if penicillin allergy Vancomycin IV as per guideline)

Use calculator

Give IV Dexamethasone base 8.3mg 6 hourly IV for 4 days (see notes below).

 

Notes:

Change ceftriaxone to benzylpenicillin 2.4g IV 4 hourly if organism sensitive

NB: Extra amoxicillin cover not required if receiving benzylpenicillin

If prolonged or multiple antibiotic use in last 3 months, or travel in last 3 months to areas outside UK contact Infectious Diseases/ Medical Microbiology for further advice.

Important: Therapy

IV Chloramphenicol 12.5mg/kg – 25 mg/kg 6 hourly

Give IV Dexamethasone base 8.3mg 6 hourly IV for 4 days (see notes below).

Notes: