Bacterial Meningitis

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Additional Information*

a Warning Signs
The following warn of impending worsening shock, respiratory failure or raised intracranial pressure and require urgent senior review and intervention
(See algorithm)

  • Rapidly progressive rash
  • Poor peripheral perfusion CRT > 4secs, oliguria and systolic BP < 90

(hypotension often a late stage)

  • RR < 8 or > 30
  • Pulse Rate < 40 or  > 140
  • Acidosis; ph < 7.3 or BE < –5
  • WBC < 4
  • Marked depressed conscious level (GCS < 12) or a fluctuating conscious level  (fall in GCS >2)
  • Focal neurology
  • Persistent seizures
  • Bardycardia and hypertension
  • Papillodema

b CT Scan and Meningitis

  • This investigation should only be used when appropriate:
  • A normal CT scan does not exclude raised intracranial pressure.
  • If there are no clinical contraindications to LP a CT scan is not necessary beforehand.
  • Subsequently a CT scan may be useful in identifying dural defects predisposing to meningitis.

c Appropriate antibiotics for bacterial meningitis

  • Review with microbiology.
  • Amoxicillin 2g IV 4 hrly should be added for individual > 50 yrs to cover listeria (co-trimoxazole 10mg/kg IV if penicillin hypersensitive)
  • Amend antibiotics on the basis of microbiology results.
  • Uncertain Hx of allergy (i.e. more than rash) or severe allergy. Chloramphenicol 25mg/kg IV and discuss with microbiology dept.

d Corticosteroids in adult meningitis
- Dexamethasone 0.15 mg/kg IV started with or just before the first dose of antibiotics, particularly where pneumoccal meningitis is suspected.

  • Do not give unless you are confident you are using the correct antimicrobials.
  • Stop the dexamethasone if non-bacterial cause is identified.

e Lumbar puncture

If there will be delay before lumbar punctures start antibiotics immediately once blood cultures have been taken and prior to lumbar puncture.

Encephalitis   Acyclovir 10mg/kg

* http://www.meningitis.org/health-professionals/hospital-protocols-adults