CNS Infections

NHSL Antimicrobial Guidelines
NHS Lanarkshire

Duration

Total duration (if clinically recovered):
- Meningococcal – 5 days 
- Pneumococcal – 10 days 
- Listeria – 21 days 
- No pathogen - 10 days
- Possible Encephalitis - 10-14 days

Possible Bacterial Meningitis

Therapy

IV Ceftriaxone 2g 12 hourly 
+ IV Dexamethasone 10mg 6 hourly for first 4 days

If penicillin resistant pneumococcus suspected
+ IV Vancomycin3

 

Penicillin intolerance/minor Penicillin allergy (see below for severe penicillin allergy/anaphylaxis)

IV Ceftriaxone 2g 12 hourly
+ IV Dexamethasone 10mg 6 hourly for first 4 days

If penicillin resistant pneumococcus suspected
+ IV Vancomycin3

 

Clear history of anaphylaxis with Penicillin or severe/true Penicillin allergy 

IV Chloramphenicol 25mg/kg (max 2g) 6 hourly
ONLY on advice of treating Consultant
+ IV Dexamethasone 10mg 6 hourly for first 4 days

 

In pregnancy – Consultant responsible for patient to discuss with Infection Specialist if required. 

- Amoxicillin not known to be harmful
- Ceftriaxone & Vancomycin - Manufacturer advises use only if benefit outweighs risk
- Chloramphenicol advised to avoid.
- Co-trimoxazole – teratogenic risk in 1st trimester & neonatal haemolysis & methaemoglobinaemia in 3rd trimester.

Notes:

Total duration (if clinically recovered):
- Meningococcal – 5 days 
- Pneumococcal – 10 days 
- No pathogen - 10 days

Listeria Meningitis

Therapy

If listeria meningitis suspected:

+ IV Amoxicillin10 2g 4 hourly 

If listeria meningitis suspected in Penicillin allergy:

+ IV Co-trimoxazole 2,10,12,13 120mg/kg/day 
(split into 2-4 divided doses).
(Adjust regimen dose/ frequency to allow simplest administration of 480mg/5ml vials)

 

In pregnancy – Consultant responsible for patient to discuss with Infection Specialist if required.

- Co-trimoxazole – teratogenic risk in 1st trimester & neonatal haemolysis & methaemoglobinaemia in 3rd trimester.

Notes:

Total duration (if clinically recovered):
- Listeria – 21 days

Listeria may be suspected if over 60 years, imunnocompromised (including diabetic, alcohol excess, liver disease, pregnancy).

Possible Encephalitis

Therapy

+ IV Aciclovir10 10mg/kg 8 hourly(use ideal body weight if patient is obese (BMI ≥ 30)

Notes:

Total duration:minimum 10-14 days discuss with infection specialist.

Notes

Doses may need to be adjusted in renal impairment. Always check the BNF for interactions. Seek advice if patient pregnant.

Drug Specific Cautions:

  1. Check interactions in the BNF. Caution may prolong QT interval.
  2. Avoid / Caution in pregnancy or breastfeeding. Consult BNF for details.
  3. Gentamicin/Vancomycin refer to online calculators.
  4. ALERT Antibiotic - Consult Second line Policy on NHS Lanarkshire Guideline App.
  5. Monitor sodium.
  6. See CURB65 definition.
  7. Reference: The Renal Drug Handbook. Online access.
  8. See Fluoroquinolones MHRA guidance on NHS Lanarkshire Guidelines App.
  9. Doxycycline and quinolones decreased absorption with iron, calcium, magnesium and some nutritional supplements. See BNF appendix 1 or pharmacy for advice.
  10. Caution in renal impairment – see BNF or pharmacy for advice.
  11. Use with caution may increase K+ and decrease renal function. Monitor.
  12. High / Excellent oral bioavailability, IV route available for NBM or vomiting.
  13. See Co-trimoxazole information for prescribers’ safety sheet on NHS Lanarkshire Guidelines App.

Editorial Information

Last reviewed: 01/12/2022

Next review date: 01/12/2025

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: NHS Lanarkshire Antimicrobial Management Committee

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.

Document Id: March 2023