Meningitis: management
Investigations suggested by NICE
Lumbar puncture if no signs of raised intracranial pressure
Management
All patients should be transferred to hospital urgently. If patients are in a pre-hospital setting (for example a GP surgery) and meningococcal disease is suspected then intramuscular benzylpenicillin may be given, as long as this doesn't delay transit to hospital.
BNF recommendations on antibiotics
If the patient has a history of immediate hypersensitivity reaction to penicillin or to cephalosporins the BNF recommends using chloramphenicol.
Management of contacts
*in the 2015 update of the NICE Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management the recommendation for initial empiracally therapy for children > than 3 months is intravenous ceftriaxone
- full blood count
- CRP
- coagulation screen
- blood culture
- whole-blood PCR
- blood glucose
- blood gas
Lumbar puncture if no signs of raised intracranial pressure
Management
All patients should be transferred to hospital urgently. If patients are in a pre-hospital setting (for example a GP surgery) and meningococcal disease is suspected then intramuscular benzylpenicillin may be given, as long as this doesn't delay transit to hospital.
BNF recommendations on antibiotics
| Scenario | BNF recommendation |
|---|---|
| Initial empirical therapy aged < 3 months | Intravenous cefotaxime + amoxicillin |
| Initial empirical therapy aged 3 months - 50 years | Intravenous cefotaxime* |
| Initial empirical therapy aged > 50 years | Intravenous cefotaxime + amoxicillin |
| Meningococcal meningitis | Intravenous benzylpenicillin or cefotaxime |
| Pneuomococcal meningitis | Intravenous cefotaxime |
| Meningitis caused by Haemophilus influenzae | Intravenous cefotaxime |
| Meningitis caused by Listeria | Intravenous amoxicillin + gentamicin |
If the patient has a history of immediate hypersensitivity reaction to penicillin or to cephalosporins the BNF recommends using chloramphenicol.
Management of contacts
- prophylaxis needs to be offered to household and close contacts of patients affected with meningococcal meningitis
- oral ciprofloxacin or rifampicin or may be used. The Health Protection Agency (HPA) guidelines now state that whilst either may be used ciprofloxacin is the drug of choice as it is widely available and only requires one dose
- the risk is highest in the first 7 days but persists for at least 4 weeks
- meningococcal vaccination should be offered to close contacts when serotype results are available, including booster doses to those who had the vaccine in infancy
- for pneumococcal meninigitis no prophylaxis is generally needed. There are however exceptions to this. If a cluster of cases of pneumococcal meninigitis occur the HPA have a protocol for offering close contacts antibiotic prophylaxis. Please see the link for more details
*in the 2015 update of the NICE Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management the recommendation for initial empiracally therapy for children > than 3 months is intravenous ceftriaxone