Bacterial Meningitis / Encephalitis
- CSF and blood cultures essential
- Additional samples: - EDTA blood for bacterial PCR - pink throat swab+stool samples for Enterovirus PCR.
- If TB meningitis is suspected - minimum of 6ml of CSF required
Ceftriaxone 2g IV 12 hourly
Add Amoxicillin 2g IV 4 hourly to cover Listeria if older than 60 years, pregnant, immunosuppressed or alcohol excess
Meropenem 2g IV 8 hourly
(no additional Listeria cover needed as meropenem has activity)
If true immediate anaphylaxis reaction to penicillin :
Chloramphenicol 25mg/kg IV 6 hourly
ADD Co-trimoxazole 1.44g IV 12 hourly to cover Listeria if > 60 years old, immunosuppressed or alcohol excess (For pregnant patients - contact microbiology for further advice)
- 9.9mg dexamethasone IV 6 hourly should be started either shortly before or alongside antibiotics in suspected meningitis.
- If antibiotics have already been started, the first dose of dexamethasone can still be given up to 12 hours after the first dose of antibiotics.
- If pneumococcal meningitis is confirmed or thought most probable, continue dexamethasone for four days and then stop.
- If another cause of meningitis is confirmed or thought probable, the dexamethasone should be stopped.
Duration depends on pathogen identified:
- Meningococcal: 5-7 days
- Pneumococcal: 10-21 days
- H. influenzae type B: 10 days
- Listeria: 21 days
- No pathogen identified: 10 days (discuss with microbiology or ID consultant)