Meningitis: Management

Question 1

What investigations does NICE suggest in someone who has suspected meningitis?

Answer 1

• Full blood count
• CRP
• Coagulation screen
• Blood culture
• Whole-blood PCR
• Blood glucose
• Blood gas
• +/- Lumbar puncture (As long as there is no raised ICP)

Question 2

What should be given in a pre-hospital setting if meningococcal disease is suspected?

When should it not be given?

Answer 2

IM Benzylpenicillin

Don’t give it will delay transit to hospital

Question 3

What antibiotics does the BNF recommend if meningococcal disease is suspected?

Answer 3

IV Benzylpenicillin or cefotaxime

Question 4

What antibiotics does the BNF recommend if pneumococcal disease is suspected?

Answer 4

IV Cefotaxime

Question 5

What should the initial therapy be for children < 3 months old?

Answer 5

IV Cefotaxime & Amoxicillin

Question 6

What should the initial therapy be for patients 3 months to 50 years?

Answer 6

IV cefotaxime

Question 7

What should the initial therapy be for patients >50 years?

Answer 7

IV Cefotaxime and Amoxicillin

Question 8

What should be offered if someone has a penicillin or cephalosporin allergy/

Answer 8

Chloramphenicol

Question 9

What 2 things should be offered to household and close contacts of patients affected with meningococcal meningitis?

Answer 9

1/ Oral ciprofloxacin or rifampicin

2/ Meningococcal vaccination/Booster doses if already had the vaccine in infancy.

Question 10

Between Ciprofloxacin and Rifampicin, which does the HPA say is the drug of choice?

Answer 10

Ciprofloxacin

Question 11

When is risk highest for a close contact to become infected?

Answer 11

First week.

Question 12

Is prophylaxis is needed for pneumococcal meningitis?

Answer 12

Generally no…unless there is a cluster of cases. If so HPA have a protocol for Abx prophylaxis.