MENINGITIS Flashcards
What is meningitis?
Infection and inflammation of the meninges of the brain.
Symptoms of meningitis
a high temperature (fever)
being sick
a headache
a rash that does not fade when a glass is rolled over it (but a rash will not always develop)
a stiff neck
a dislike of bright lights
drowsiness or unresponsiveness
seizures (fits)
Meningitis in babies
refuse feeds
be irritable
have a high-pitched cry
have a stiff body or be floppy or unresponsive
have a bulging soft spot on the top of their head
What are the causes of meningitis?
- Several causative organisms.
- Older children/ adults: Neisseria meningitidis, s.pneumoniae
- Kids: h.influenzae b
non-blanching rash
rash that does not fade under pressure
What is initial empirical therapy of meningitis if meningococcal disease (meningitis WITH non blanching RASH or meningococcal septicaemia) is suspected
give single dose of benzylpenicillin before hospital if this does not delay transfer
what is initial empirical therapy for suspected bacterial meningitis WITHOUT non blanching RASH (plus alternatives)
- benzylpencillin before transfer
alternative in allergy: cefotaxime
if history of immediate hypersensitivity to penicillin or cephalosporins: chloramphenicol
Treatment: in hospital
Ceftriaxone/cefotaxime
Often in combination with corticosteroids (dexamethasone)
Depends on confirmed diagnosis.
when giving dexamethasone, preferably start before or with first dose of abx, but no later than …. after starting abx
12 h
in hospital consider adjunct treatment with dexamethasone esp if ….
pneumococcal meningitis suspected in adults
avoid dexamethasone in the following (4)
septic shock
meningococcal septicaemia
immunocompromised
meningitis following surgery
In hospital of aetiology unknown: adult and child 3 months - 59 yrs
cefotaxime or ceftriaxone
- consider vancomycin
10 days
In hospital of aetiology unknown: adult 60 +
cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)
consider vancomycin
10 days
When would you consider vancomycin in meningitis
- prolonged or multiple use of other antibacterials in last 3 months
- traveled in last 3 months to areas outside the UK with highly penicillin and cephalosporin-resistant pneumococci
Prevention
o HiB
o PCV
o MenC
o MenACWY
