Clinical definition:
Inflammation of meninges and subarachnoid space. Common symptoms include headache, fever, stiff neck, reduced consciousness. Major causes of bacterial meningitis include N. meningitidis, S. pneumoniae, L. monocytogenes.
| Preferred antibiotic choice(s) | |||
| Drug | Formulation | Dosage | Duration |
| Ceftriaxone (IV) | Powder for injection: 250 mg; 1 g (as sodium salt) in vial | 2 g 12 hourly | If culture negative: 10 days. In case of proven S. pneumoniae infection: 14 days |
| Cefotaxime (IV) | Powder for injection: 250 mg per vial (as sodium salt | 2 g 6 hourly | |
| Alternative antibiotic choice(s) | |||
| Ampicillin (IV) | Powder for injection: 500 mg; 1 g (as sodium salt) in vial | 3 g 6 hourly | 10 days, or if confirmed L. monocytogenes: 3 weeks |
| Benzylpenicillin (IV) | Powder for injection: 600 mg; 3 g (sodium or potassium salt) in vial | 4 MU 4 hourly | 10 days |
| Chloramphenicol (IV)A | Powder for injection: 1 g (sodium succinate) in vial | 1 g 6 hourly | 10 days |
| In case of non-severe penicillin allergy | |||
| Ceftriaxone | Powder for injection: 250 mg; 1 g (as sodium salt) in vial | 2 g 12 hourly | If culture negative: 10 days. In case of proven S. pneumoniae infection: 14 days |
| Cefotaxime (IV) | Powder for injection: 250 mg per vial (as sodium salt | 2 g 6 hourly | |
| In case of severe Penicillin allergy | |||
| Moxifloxacin (IV, PO) | Tablet: 400 mg or 100 mg (dispersible); Injectable solution: 400mg/250 mL | 400 mg once daily | If culture negative: 10 days. In case of proven S. pneumoniae infection: 14 days |
A. Chloramphenicol is not preferred and should only be used if other listed antibiotics are not available.
Principles of Stewardship:
- Acute meningitis may be caused by a range of pathogens, some of which are not bacteria. Microbiologic diagnosis, including bacterial culture from CSF and blood, should be obtained as soon as possible to confirm etiology.
- In presentations of subacute or chronic nature, consider diagnostic tests for TB meningitis, particularly in HIV-endemic areas.
Notes:
- Add ampicillin in situations of confirmed Listeria outbreaks and for patients at high risk for Listeria including:
- Patients over 50 years of age
- Immunosuppressed patients – cancer, transplantation etc.
- Patients with alcoholism, cirrhosis, etc.
- Pregnant women