Bacterial meningitis

Question 1

Empiric treatment for < 1 month old (incl duration)

Answer 1

IV Ceftriaxone + Ampicillin x 14d

Question 2

Empiric tx for 1-23 months old

Answer 2

IV Ceftriaxone + Vancomycin x 14d

Question 3

Empiric tx for adult 2-50 y/o

Answer 3

IV Ceftriaxone + Vancomycin x 14d

Question 4

Empiric tx for adult > 50y/o (incl duration)

Answer 4

IV ceftriaxone + vancomycin + ampicillin x 14d

Question 5

Culture-directed for S. pneumoniae (Penicillin susceptible)

Answer 5

Penicillin G or Ampicillin
x10 - 14d

Question 6

Culture-directed for S. pneumoniae (Penicillin resistant, cephalosporin susceptible)

Answer 6

Ceftriaxone x10 - 14d

Question 7

Culture-directed for S. pneumoniae (Penicillin, cephalosporin resistant)

Answer 7

Vancomycin plus rifampicin
x10 - 14d

Question 8

Culture-directed N. meningitidis (Penicillin susceptible)

Answer 8

Penicillin or Ampicillin

Question 9

Culture-directed N. meningitidis (Penicillin resistant or mild allergy)

Answer 9

Ceftriaxone x 5-7d

Question 10

Culture-directed L. monocytogenes (no penicillin allergy)

Answer 10

Penicillin G or Ampicillin
x at least 21 days

Question 11

Culture-directed L. monocytogenes (Penicillin allergy)

Answer 11

Co-trimoxazole, meropenem
x at least 21 days

Question 12

Culture-directed S. agalactiae (no penicillin allergy)

Answer 12

IV Penicillin or Ampicillin
x 14-21d

Question 13

Culture-directed S. agalactiae (Penicillin, mild allergy)

Answer 13

IV Ceftriaxone
x 14-21d

Question 14

Regimen & counselling for dexamethasone (adult)

Answer 14

Dexamethasone 10 mg every 6 hours for up to 4 days. Administer 10–20 minutes before or at same time as first dose of antibiotics.

Question 15

If culture-negative, treat with __(what)___for ( ) days, may be extended depending on condition of patient.

Answer 15

empiric antibiotic for at least 14 days

Question 16

Who could be given adjunctive corticosteroids?

Answer 16

• Meningitis caused by strep pneumo/ h. influenzae
• More than 6 weeks old

Question 17

Chemoprophylaxis regimen for close contact (Neisseria)

Answer 17

Rifampicin:
- Adults: 600 mg every 12 hours, four doses
- Children: 10 mg/kg every 12 hours, four doses
- Infants (younger than 1 month): 5 mg/kg every 12 hours, four doses

OR
- PO Ciprofloxacin 500 mg, one dose (adults only)
OR
- IM Ceftriaxone 125–250 mg, one dose