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Guidelines
Meningitis

Meningitis

Microbiology

Clinical Considerations

  • Inflammation of meninges covering the brain and spinal cord
  • Severe headache, neck pain and stiffness, altered mental status
  • Systemic symptoms: fever, chills, vomiting and photophobia

Diagnosis

  • Lumbar puncture (LP) of cerebrospinal fluid (CSF) and analysis can help guide therapy before C&S results are available
    • Do not delay antibiotic initiation if the LP is delayed
  • CT scan may be required

Treatment

PLUS

PLUS

Acyclovir
​

For suspected encephalitis

PLUS

Dexamethasone 0.15 mg/kg (max: 10 mg/dose) IV q6h

  • Can be continued for 4 days
  • Should be given 15-20 minutes prior to or with 1st antibiotic dose to prevent neurological complications

ADD

Ampicillin 2g q4h
​

If age < 2 yr. and > 50 or immunocompromised patients to cover Listeria

Duration of Therapy

Neisseria meningitidis: 7 days

Haemophilus influenzae: 7 days

Streptococcus agalactiae: 14-21 days

Streptococcus pneumoniae: 10-14 days

Aerobic gram-negative bacilli: 21 days

Listeria monocytogenes: 21 days

Additional Information

Allan R. Tunkel, Barry J. Hartman, Sheldon L. Kaplan, Bruce A. Kaufman, Karen L. Roos, W. Michael Scheld, Richard J. Whitley, Practice Guidelines for the Management of Bacterial Meningitis, Clinical Infectious Diseases, Volume 39, Issue 9, 1 November 2004, Pages 1267–1284, https://doi.org/10.1086/425368