Bacterial Meningitis

• Meningococcal meningitis can be rapidly fatal
• Do not delay antibiotics pending microbiological results
• Diagnosis should be considered in any patient with headache and fever
• In seriously unwell patients, do not delay antibiotics for CT brain or LP
• The appearance of a purpuric rash is a LATE sign 
• The absence of meningism does not exclude the diagnosis - Kernig's and Brudzinski's sign are insensitive
• Have a high degree of suspicion in any febrile neonate/infant

Causative organisms

• Meningococcus (N. Menigitiditis)
• Pneumococcus (S. Pneumoniae)
• H. Influenzae (Type B) - rare due to immunisation
• Listeria Monocytogenes - esp. neonates, elderly, immunocompromised

Diagnostic features

• Headache
• Fever

+/-

• Photophobia
• Neck Stiffness
• Rash

Assessment - risk stratification

* pre-verbal children present with non-specific features

Management

• IV access, FBC, Blood culture

High risk

• IV antibiotics

Moderate risk

• Lumbar puncture
• IV antibiotics

Low risk

• Lumbar puncture - await urgent microscopy and gram stain
• IV antibiotics (if CSF WBC, bacteria or decreased glucose)

Do not perform LP if GCS < 15 or focal neurological signs

Antibiotic therapy (see Antibiotic guidelines)

Empiric - Pre-hospital

• 1st line - IV ceftriaxone 50g/kg (up to 2g)  +  IV penicillin 60g/kg (up to 1.8g) 
• 2nd line - IV ampicillin 60mg/kg (up to 2g)
• 3rd line - augmentin duo forte 875/125 three tablets PO

Empiric - Hospital

• IV ceftriaxone 50g/kg (up to 2g)  6/24 +
• IV penicillin 60g/kg (up to 1.8g) 6/24 

+/-

• IV vancomycin 15mg/kg (up to 500mg) 12/24 (if penicillin-resistant pneumoccocus is prevalent or gram +ve diploccocci present on CSF)

Specific therapy