Meningitis

Last updated 20.09.12

 

Index

 

-  Paediatric Meningitis

 

Description

-   

 

Features

-   

-  Orbital cellulitis

 

Causes

-  Bacteria

-  Neisseria meningitides

-  Streptococcus pneumoniae

-  Haemophilus influenzae type b (Hib)

-  Streptococcus agalactiae (GBS)

-  Listeria monocytogenes

-   More common >50yrs old or immunocompromised

-  Viral

-  Herpes Simplex Type 1 (HSV1)

-  Enterovirus

-  Fungal

 

Associated S/S

-  Headache

-  Photophobia +/- phonophobia

-  Neck stiffness

-  Positive Kernigs sign

-  Vomiting

-  Impaired counscious state

 

Ix

-  GCS

-  Vitals

-  Temp: fever

-  BP: shock

-  BC

-  Prior to antibiotics

-  Ideally from x2 separate sites

-  Withing 30minutes of presentation

-  FBE

-  CRP

-  CT-Brain

-  Prior to LP if suspecting possible IICP

-  LP

-  Avoided initially if neurological defecit, seizure, palilloedema, perforated ear drum

 

Mx

-  For kids <3 months see Paediatric Meningitis

-  Corticosteroids

-  Early Dexamethasone improves outcomes: mortality, hearing loss, neurological sequelae if >3 months to adulthood & suspected bacterial meningitis

-  Given prior to first dose of antibiotics

-  Dexamethasone 10mg (child 0.15mg/kg, max 10mg) IV 6/24 4/7

-  OR if not available Hydrocortisone 250mg IV

-  Antibiotics

-  Must not be delayed once Dx made

-  If steroids are to be used they should be given prior to antibiotics

-   If steroids not immediately available do not delay antibiotics

-  BC should be taken prior

-  Empirical therapy

-   If no pathogen identified from Ix therapy for 10 days

-   If suspecting meningococcaemia (fever, rash) immediate Benzylpenicillin IV or IM

-   Penicillin hypersensitivity Cetriaxone

-   Immediate Penicillin hypersensitivity seek advice +/- Ciprofloxacin or Moxafloxacin

-   >3months to adulthood

-   Ceftriaxone 4g (child 100mg/kg, max 4g) Daily OR 2g (child 50mg/kg, max 2g) 12/24 IV

-   OR Cefotaxime 2g (child 50mg/kg, max 2g) IV 6/24

-   If suspecting Listeria: >50yrs old or immunocompromised, EtOH depedance, pregnancy

-   PLUS Benzylpenicillin 2.4g (child 60mg/kg, max 2.4g) IV 4/24

-   If gram postive diplococci seen, pneumococcal CSF assay positive, recent otitis media or sinusitis or recent Rx with beta lactam antibiotic

-   PLUS Vancomycin 1.5g (child <12yrs 30mg/kg, max 1.5g) IV 12/24

-   If immediate penicillin hypersensitivy &/or cephalosporin

-   Vancomycin (dose as above)

-   PLUS

-  Ciprofloxacin 400mcg (chil 10mg/kg, max 400mg) IV 12/24

-  OR Moxifloxacin 400mg (child 10mg/kg, max 400mg) IV daily

-  Organism Specific Mx

-   Neisseria meningitides

-   Prophylaxis for close contacts

-   Benzylpenicillin 1.8g (child 45mg/kg, max 1.8g) IV 4/24 3-5/7

-   Penicillin hypersensitivity

-  Ceftriaxone 4g (child 100mg/kg, max 4g) Daily OR 2g (child 50mg/kg, max 2g) 12/24 IV 3-5/7

-  OR Cefotaxime 2g (child 50mg/kg, max 2g) IV 6/24 3-5/7

-   Immediate Penicillin hypersensitivity

-  Ciprofloxacin 400mcg (chil 10mg/kg, max 400mg) IV 12/24 3-5/7

-  OR Chloramphenicol 1g (child 25mg/kg, max 1g) IV 6/24 3-5/7

-   Streptococcus pneumoniae

-   Benzylpenicillin 2.4g (child 60mg/kg, max 2.4g) IV 4/24 10-14/7

-   OR Ceftriaxone 4g (child 100mg/kg, max 4g) Daily OR 2g (child 50mg/kg, max 2g) 12/24 IV 10-14/7

-   OR Cefotaxime 2g (child 50mg/kg, max 2g) IV 6/24 10-14/7

-   Haemophilus influenza type b

-   Ceftriaxone 4g (child 100mg/kg, max 4g) Daily OR 2g (child 50mg/kg, max 2g) 12/24 IV 7/7

-   OR Cefotaxime 2g (child 50mg/kg, max 2g) IV 6/24 7/7

-   If <2yrs commence full vaccination ASAP after recovery (regarless of previous vaccination)

-   Streptococcus agalactae (GBS)

-   Benzylpenicillin 2.4g (child 60mg/kg, max 2.4g) IV 4/24 14-21/7

-   Listeria monocytogenes

-   Benzylpenicillin 2.4g (child 60mg/kg, max 2.4g) IV 4/24 14-21/7 3/52

-   Penicillin hypersensitivity Bactrim 160+800mg (child 4+20mg/kg) IV 6/24 2/52

-   Cease corticosteroids (of no proven benefit)

-   Cryptococcal neoformans or gattii

-   ID consultation

-   Amphotericin B desoxycholate 0.7-1mg/kg IV Daily 2/52+

-  Exposure Chemoprophylaxis

-   Neisseria meningitides

-   Ceftriaxone 250mg (child 125mg) IM single dose

-  Preferred option in pregnancy

-   OR Ciprofloxacin 500mg PO single dose

-  Preferred option for women on oral contraceptive

-   OR Rifampicin 600mg (Neonate 5mg/kg, child 10mg/kg, max 600mg) PO 12/24 2/7

-  Preferred option for children

-  Contraindicated in pregnancy, EtOH dependance, severe liver disease

-   Haemophilus influenza type b

-   Rifampicin 600mg (Neonate 5mg/kg, child 10mg/kg, max 600mg) PO 12/24 247

-   OR Ceftriaxone 1g (child 25mg/kg, max 1g) IM daily 2/7

-   PLUS vaccinate contacts <5yrs if not already

 

 

 

References