Meningitis / meningoencephalitis and meningococcal sepsis
Antimicrobial prescribing: NHS Fife
Clinical Features
- Headache
- Fever
- Altered consciousness
- Neck stiffness
- Nausea and vomiting
- Rash
- Seizures
- Shock
Suspect Listeria in patients who are immunocompromised, over 50 years old, or peripartum
Investigations
Lumbar puncture
- Bacterial culture
- Viral PCR
- Cell counts / microscopy
- Protein and glucose
- Serum glucose (at the same time as LP)
Blood culture
Bacterial throat swab
Viral throat swab
Blood (EDTA) for meningococcal PCR
Infection Control
- Isolate
- Droplet precautions
- Fluid resistant surgical facemask for routine care, and FFP3 mask for intubation or other procedures involving airway, until established on appropriate antimicrobial treatment.
Treatment
|
Give DEXAMETHASONE (10mg IV) at an early stage for suspected meningitis See full guidance: Meningitis Research Foundation guidelines |
CEFTRIAXONE (IV) 2g 12 hourly
If true penicillin allergy (anaphylaxis)
CHLORAMPHENICOL (IV) 25 mg / kg 6 hourly
If Listeria suspected: add
AMOXICILLIN (IV) 2g 4 hourly
If Listeria suspected and true penicillin allergy (anaphylaxis): instead add
COTRIMOXAZOLE (IV) 1.44g 12 hourly
Duration: Review at 7 days, or when a pathogen is identified
CEFTRIAXONE is unrestricted for this indication
Obtain travel history and consider adding VANCOMYCIN IV if recently overseas or prolonged / multiple antibiotic exposure in last 3 months
Contact the Health Protection Team for advice about prophylaxis for community contacts