Acute bacterial meningitis

Treatment (contd)

Therapy after organism identification

ORGANISM

ANTIBIOTIC

CHILD mg/kg/day

ADULT

ALTERNATIVE THERAPY

Haemophilus

Chloramphenicol and/ or cefotaxime

100 200

2-4 g/day 6-12 g/day

Ampicillin Cefuroxime

Pneumococcus

Benzylpenicillin

180

20 million units

Chloramphenicol

Cefotaxime

Cefuroxime

Meningococcus

Benzylpenicillin

180

20 million units

Chloramphenicol Cetatamin

E. coli

Cefotaxime

200

6-12 g/day

Ampicillin Gentamicin

Listeria

Ampicillin + gentamicin

(5-7 mg/kg/day)

Chloramphenicol Cotrimoxazole

Duration

Meningococcus I

... > continue for at least 1 week after afebrile. Haemophilus

Pneumococcus - continue for 10-14 days after afebrile. Monitoring

In a deteriorating patient, CT scan will exclude the development of hydrocephalus, abscess or subdural empyema. In suspected sinus thrombosis MR venography may be required.

Remove any source of infection, e.g. mastoidectomy or sinus clearance. In meningococcal meningitis the risk to household contacts is increased (500-800 x) and chemoprophylaxis should be offered - rifampicin 600 mg b.d. for 48 hours. Vaccines are also available.

In the critically ill, intensive supportive therapy may be required. Recent trials in children suggest that adjunctive therapy with steroids (dexamethasone) improves outcome -this may be due to reducing cytokines, released when organisms are destroyed. In adults benefit of steroids is less certain.

Meningitis ICSF shunts

Meningitic infection may follow CSF drainage operations for hydrocephalus. This may occur in the immediate postoperative period or be delayed for weeks or months. Clinical features of raised intracranial pressure may coexist due to shunt blockage. Bacteraemia is inevitable and blood cultures identify the responsible organism - usually Staphylococcus albus. The infection seldom resolves with antibiotic therapy alone and shunt removal is usually required.

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