Bacterial Meningitis


Neisseria meningitides

Streptococcus pneumoniae


7 days for meningococcal, 14 days for pneumococcal


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) guidelines/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
1st Line

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 preferred calculator on Hospital portals page [intranet access only] or calculator on app for intermittent dosing

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


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 ID/ microbiology for further advice.

2nd line, or in severe penicillin/ cephalosporin allergy

IV Chloramphenicol 12.5 – 25 mg/kg 6 hourly

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


NB 8.3mg dexamethasone base is 2.5ml of dexamethasone base injection 3.3mg/ml

8.3mg dexamethasone base is equal to 10mg dexamethasone sodium phosphate