Hospital management of Bacterial Meningitis in adults

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Hospital management of Bacterial Meningitis in adults.

Patient NOT >55 years of age, pregnant or immunocompromised:

Start IV Ceftriaxone 2g bd
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 with penicillins or rash with cephalosporins, ceftriaxone is contraindicated, use IV Chloramphenicol 12.5mg/kg qds (maximum dose 1g qds) and discuss urgently with Microbiology/Infectious diseases.
Add Dexamethasone (before or with the first dose of antibiotic) if the patient has a high likelihood of bacterial meningitis, based on clinical features or CSF examination.
Review choice of antibiotics regularly with results

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

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

PLEASE NOTE: Ceftriaxone must not be mixed with calcium containing intravenous solutions and must not be given simultaneously with calcium containing solutions, even via different infusion lines. See link for further information including advice on calcium containing TPN.

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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.