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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