Hospital management of Bacterial Meningitis in adults.

Patient is pregnant/ immunocompromised/recent history of travel

Discuss ALL cases with microbiology/infectious diseases

Patient is >55 years old

• Additional cover is required for Listeria so start:

  Ceftriaxone IV 2g bd PLUS Amoxicillin IV 2g 4 hrly

• If severely ill, take blood cultures first and then start immediately. Do not wait for lumbar puncture.
• If the patient has a history of anaphylaxis or rash with penicillins or rash with cephalosporins, ceftriaxone is contraindicated discuss urgently with microbiology/infectious diseases.

In addition to antibiotics, Dexamethasone should be given if there the patient has a high likelihood of bacterial meningitis, based on clinical features or CSF examination.

Suspicion of acute viral encephalitis

• If an individual has altered mental state and there is a suspicion of acute viral encephalitis start Aciclovir IV 10mg/kg tds in addition to IV Ceftriaxone 2g bd and Amoxicillin IV 2g 4 hrly

All these treatments are empirical and should be discussed with infectious diseases/microbiology at the earliest opportunity.

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Caution; the antibiotic doses recommended on this website are intended for adult patients with normal renal and liver function unless otherwise stated. Dosing advice for patients with renal impairment is available here.

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