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By ULY CLINIC

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Bacterial infections

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Bacterial Meningitis

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Introduction

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Is a serious infection in which there are inflammations of the layers (meninges) covering the brain and spinal cord. Causative bacteria differs among different age groups 

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Diagnostic criteria

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  • Headache, high fever

  • Confusion, convulsions, coma may occur.

  • Photophobia

  • Nausea and vomiting 

  • neck stiffness and other signs of meningeal irritations 

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Children

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In infants under 1 year diagnosis is much more difficult therefore always think of it in a sick child if:  Refusal to eat and or suckle, drowsiness and weak cry

  • Focal or generalized convulsions  Fever may be absent

  • Irritability

  • Hypotonia, neck is often not stiff

  • Bulging fontanel 

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NOTE: A lumbar puncture for CSF analysis is essential to confirm diagnosis 

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Supportive therapy 

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  • Control of fever and pain(refer fever and pain section) 

  • Control convulsions( see section convulsions)

  • If unconscious, insert NGT for feeding and urethral catheter 

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Pharmacological Treatment

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Where the organism is not known:​

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Adults

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  • Chloramphenicol 1000mg IV 6 hourly for 14 days

Plus

  •  Benzyl penicillin 5MU IV 6 hourly for 14 days.

OR

  • Ceftriaxone IV 2 g 12 hourly for 14 days

OR

  • Cefotaxime 2 g IV 6 hourly for 10–14 days

Plus

  • Ampicillin IV 2g 6 hourly for 10–14 days

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Plus either 

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  • Cefepime 2 g IV every 8 hours 10–14 days 

OR  

  • Meropenem 2 g IV every 8 hours 10 days 

 

Where the organism is known:

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Meningococcal meningitis  

 

Adults & children >2yrs

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  • Ceftriaxone IM 100mg/kg as a single dose (divide into 2 injections if needed & inject half-dose in each buttock)

 

Haemophilus influenza meningitis

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  • Ceftriaxone IV 2g 12 hourly for 14 days

OR

  • Cefotaxime 2g IV 6 hourly for 10 days

OR

  • Chloramphenicol 1g IV 6 hourly for 7–10 days.

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Children
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  • Ampicillin 50–100 mg/kg 6 hourly for 10 days

OR

  • Chloramphenicol 50 mg/kg 6 hourly for 10 days

 

Pneumococcal meningitis

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  • Benzyl penicillin 5MU IV 6 hourly for 14 days

OR

  • Ceftriaxone IV 2 g 12 hourly for 14 days

OR

  • Ceftriaxone + Salbactam (IV) 1.5mg twice daily for 14 days

OR

  • Cefotaxime 2g IV 6 hourly for 10 days

 

Updated on, 31.10.2020

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References

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1. STG 

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