Confirmed meningitis

NHS Tayside ED Guidance
NHS Tayside

Antibiotics for confirmed meningitis:

  • Group B Strep: IV cefotaxime for at least 14 days OR IV benzylpenicillin for at least 14 days plus IV gentamicin for first 5 days
  • N. Meningitidis: IV ceftriaxone for 7 days
  • H. influenzae: IV ceftriaxone for 10 days
  • S. pneumoniae: IV ceftriaxone for 14 days
  • L. monocytogenes: IV amoxicillin for 21 days in total plus IV gentamicin for at least the first 7 days
  • Gram-negative bacilli: IV cefotaxime for at least 21 days unless directed otherwise by antibiotic sensitivities

Duration may be dictated by clinical response, if poor/complicated d/w microbiology or ID expert

Ceftriaxone and cefotaxime are interchangeable.

Contraindications to ceftriaxone: as per BNFc: 

  • under 41weeks corrected gestational age
  • Neonates over 41weeks corrected gestational age with:
    • jaundice
    • acidosis
    • hypoalbuminaemia
    • simultaneous administration of calcium-containing infusions (inc total parenteral nutrition containing calcium)

Consider ambulatory/home antibiotics in selected cases.

Follow up and long term management:

  • Use MRF discharge checklist .
  • Before discharge: consider need for after care, discuss potential long-term effects with parents and arrange hearing test within 4 weeks of being fit enough to test.
  • Refer severe or profoundly deaf children for cochlear implant assessment ASAP.
  • Direct to support organisations such as Meningitis Research Foundation, Meningitis Now & GBS Support.
  • Arrange paediatric review with results of hearing test 4-6 weeks after discharge from hospital.
  • Consider all potential morbidities at discharge and offer referral.
  • Inform GP and health visitor.
  • Follow up until at least 2 years of age

Notify public health: see public health guidance for prophylaxis of household contacts