2.3 Meningitis syndrome
| Type of Infection | First Line (with Dosage and Duration) |
Alternative First Line (with dosage and Duration) |
Comments |
|---|---|---|---|
| Acute Meningitis | Ceftriaxone 2g IV 12 h Or Cefotaxime 2g IV 4-6 h + Vancomycin 25 mg/kg IV stat followed by 15mg/kg q 8-12h (if penicillin or Ceftriaxone/ Cefotaxime resistance in pneumococcus is a concern) Duration:10-14 days | In immunocompromised and patients with age more than 50 yrs Inj Meropenem 2g IV q8hr + Vancomycin 25 mg/kg IV stat followed by 15mg/kg q8-12h Duration:10-14 days | Antibiotics should be started as soon as possible without waiting for CT scan or LP results. If difficult to distinguish between meningitis and encephalitis, follow same treatment as under encephalitis. Duration of therapy: 10-14 days. If infection with Listeria spp. is suspected, add Inj Ampicillin 2g q4h IV (immunocompromised/pregnant host) Duration of therapy in Listeria infections: 21 days. |
For common etiological agents of Meningitis syndrome, see Annexure B.2.3
Additional Information
- Treat bacterial meningitis due to Gram-negative bacilli or Staphyloccocus spp. for at least 21 days.
- May need intra ventricular antimicrobial therapy in severe cases.
- Pyogenic meningitis should be differentiated from tubercular meningitis, which has relatively longer history of low to high grade of fever, constitutional symptoms, and CSF shows lymphocytic predominance, normal to mildly reduced sugar and raised proteins.
- A high index of suspicion must be maintained to diagnose amoebic meningoencephalitis especially if an epidemiologic link is present.
References
1. Van de Beek D, Cabellos C, Dzupova O, Esposito S, Klein M, Kloek AT, Leib SL, Mourvillier B, Ostergaard C, Pagliano P, Pfister HW, Read RC, Sipahi OR, Brouwer MC; ESCMID Study Group for Infections of the Brain (ESGIB). ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. doi: 10.1016/j.cmi.2016.01.007. Epub 2016 Apr 7. PMID: 27062097.