Meningitis and Viral Meningo Encephalitis

For CSF shunt, Post neurosurgery and penetrating trauma discuss with Frenchay

Severity(classification)

1st line oral/iv antibiotics

Penicillin allergy
(see explanatory notes)

A/B/C

Grading not applicable

Meningitis
Consider Critical Care/Neurology review

DEXAMETHASONE PHOSPHATE 10mg iv every 6 hours for 4 days
(Note: this dose is equivalent to 8.3mg of dexamethasone base)
Started with or just before the first dose of antibiotic(s)
plus
CEFTRIAXONE 2g iv every 12 hours for complete course

 

  • If patient:
    • >50 years
    • immunocompromised
    • alcoholic
    • diabetic
    • pregnant

ADD:
AMOXICILLIN 2g iv every 4 hours

Continue for a minimum of 5 days antibiotic treatment then discuss with microbiologist. Significant microbiology results should be used to refine treatment after discussion

Meningitis
Consider Critical Care/Neurology review

DEXAMETHASONE PHOSPHATE 10mg iv every 6 hours for 4 days
(Note: this dose is equivalent to 8.3mg of dexamethasone base)
Started with or just before the first dose of antibiotic(s)
plus

Non-Severe Penicillin Allergy:

CEFTRIAXONE 2g iv every 12 hours for complete course

 

If patient:
  • >50 years
  • alcoholic
  • diabetic
  • pregnant

ADD:
CO-TRIMOXAZOLE 30mg/kg iv every 6 hours

Severe Penicillin Allergy:

VANCOMYCIN iv (See local policy)

plus

CHLORAMPHENICOL 25 mg/kg iv every 6 hours

 

If patient:
  • >50 years
  • alcoholic
  • diabetic
  • pregnant

ADD:
CO-TRIMOXAZOLE 30mg/kg iv every 6 hours

Continue for a minimum of 5 days antibiotic treatment then discuss with microbiologist. Significant microbiology results should be used to refine treatment after discussion

A/B/C

Grading not applicable

Viral Meningo Encephalitis
If suspected Viral meningo encephalitis e.g. due to Herpes simplex or Varicella-zoster, use:
ACICLOVIR 10mg/kg iv every 8 hours for 10 - 21 days

Not Applicable

Last reviewed:  18/06/2014

For guidance on the administration of intravenous antibiotics click here
(GHNHSFT intranet)