Bacterial Meningitis

Clinical Description

• Before starting treatment make sure to take a CSF sample for Gram staining, CSF analysis, culture, and sensitivity. Adjust the antibiotic management based on the laboratory report.
• In hospital, start an IV infusion for antibiotics using Dextrose 5% (not more than 50 mL/kg per day for an infant) and continue until oral medication can be tolerated
• sometimes corticosteroids may be of help
• Give antibiotics for at least 14 days, if there is a good response in meningococcal disease stop at 7 days
• Do a repeat CSF

Treatment

Adults (empirical treatment pending test results)

• Give Ceftriaxone 2g IV 12 hourly

Alternatively

• Give Chloromphenical 1g IV 6 hourly
• Give Benzyl penicillin 5MU IV 6 hourly

Use the alternative regime only when ceftriaxone is not available and evidence of culture and sensitivity of the invading organism to Chloramphenicol.

Children

• Give Ceftriaxone 100mg/kg IM or IV 24 hourly for 7 days

Alternatively

• Chloramphenicol 25mg /kg IV 8 hourly plus
• Benzylpenicillin 100,000 IU/kg 6 hourly IV/IM

Meningitis in Neonates

• Usually caused by gram (-) organisms and requires treatment for 21 days.
• Careful observation is essential while awaiting culture and sensitivity results.

or if they are not available:

• Give Benzylpenicillin 100,000 units/kg q6h, initially slow IV or IM plus Gentamycin 2.5 mg/kg IM or IV q8h or Gentamycin 5mg/kg IM q24h if 1 week old neonate. Or

Gentamycin 7.5 mg/kg q24h if over a week-old neonate.

Alternatively

• Give Ampicillin 50 mg/kg 6 hourly initially IV then later IM as an alternative to

Benzylpenicillin

If still febrile after 48 hours:

• Add Cefotaxime