CNS infections

Question 1

Emergency treatment of strongly suspected bacterial meningitis or meningococcal disease prior to transfer to hospital

Answer 1

Ceftriaxone or benzylpenicillin sodium.
Do not give antibacterials outside of hospital if the patient has a severe allergy to a beta-lactam antibacterial.

Question 2

Empirical antibacterial therapy for suspected bacterial meningitis in hospital

Answer 2

First line (including patients with non-severe allergy to a beta-lactam antibacterial): ceftriaxone. If ceftriaxone is contra-indicated for reasons other than allergy, cefotaxime may be used.
Alternative in patients with severe allergy to a beta-lactam antibacterial: consider chloramphenicol and seek advice from an infection specialist

Question 3

Antibacterial therapy for meningococcal disease in hospital

Answer 3

First line (including patients with non-severe allergy to a beta-lactam antibacterial): ceftriaxone.
Alternative in patients with severe allergy to a beta-lactam antibacterial: consider chloramphenicol and seek advice from an infection specialist.