Hospital management of Bacterial Meningitis in adults.

Treatment  to eliminate pharyngeal carriage:

Meningococcal disease: 

Index case:

• Ceftriaxone eliminates carriage of meningococcus. Patients with meningococcal disease who have not received ceftriaxone should be given oral ciprofloxacin 500mg stat or Rifampicin 600mg bd for 2 days. 
• As ciprofloxacin can increase selection for C.difficile infection and MRSA colonisation/infection, all patients with previous MRSA/C.difficile  require microbiology approval to use ciprofloxacin.
• Both are contra-indicated in pregnancy so advice should be sought from microbiology

Close contacts:

 Prophylaxis should be given to those living in the same household and those with kissing/secretion contact with the patient within the last 10 days, or performed mouth to mouth resuscitation , or have had definite droplet contamination from respiratory secretions.

• Rifampicin     >12 yrs/adults 600mg bd for 2 days

                                   1-12 years 10mg/kg bd for 2 days (max 600mg bd)

                                    <12 months 5mg/kg bd for 2 days

• Both are contraindicated in pregnancy- If pregnant then give ceftriaxone 250mg IM stat.

Pneumococcal disease:. No prophylaxis required.

Haemophilus influenzae: if patient lives with an unvaccinated child  aged <4, the entire household, including patient, must be given prophylaxis with Rifampicin:

• >12 yrs/adults:  600mg od for 4 days
• 3 months- 12 yrs 20mg/kg (max 600mg) once daily for 4 days
• 1-3 months:  10mg/kg once daily for 4 days

(NB most children in the UK are vaccinated at 2,3 and 4 months of age)

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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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