Bacterial Meningitis / Encephalitis

First Line

Ceftriaxone 2g IV every 12 hours.

Add Amoxicillin 2g IV every 4 hours to cover Listeria monocytogenes if older than 55 years, pregnant, immunosuppressed or alcohol excess

Course Lengths

  • Meningococcal: at least 7-10/7
  • Pneumococcal: 14-21/7
  • H.Influenzae:  at least 10/7
  • Listeria monocytogenes: 21/7
Penicillin Allergy

Meropenem 2g IV 8hrly

If true immediate anaphylaxis reaction to penicillin then

Chloramphenicol 50-100mg/kg in 4 divided doses IV (Max 4g/day)

Add Co-trimoxazole 1.44g IV every 12 hours to cover Listeria monocytogenes, if older than 55 years, immunosuppressed or alcohol excess (For pregnant patients - contact microbiology for further advice)

Course Lengths

  • Meningococcal: at least 7-10/7
  • Pneumococcal: 14-21/7
  • H.Influenzae:  at least 10/7
  • Listeria monocytogenes: 21/7
Notes

Give Dexamethasone 0.15mg/kg, 6 hourly for 4 days ASAP if baterial meningitis suspected / confirmed and patient on correct antibiotics.

Samples required

  • CSF and blood cultures essential
  • Additional samples: EDTA blood for bacterial PCR and stool + throat swab samples for Enterovirus PCR.
  • If TB meningitis is suspected - a minimum of 6mls of CSF is required