MENINGITIS

Question 1

What is meningitis?

Answer 1

Infection and inflammation of the meninges of the brain.

Question 2

Symptoms of meningitis

Answer 2

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)

Question 3

Meningitis in babies

Answer 3

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

Question 4

What are the causes of meningitis?

Answer 4

• Several causative organisms.
• Older children/ adults: Neisseria meningitidis, s.pneumoniae
• Kids: h.influenzae b

Question 5

non-blanching rash

Answer 5

rash that does not fade under pressure

Question 6

What is initial empirical therapy of meningitis if meningococcal disease (meningitis WITH non blanching RASH or meningococcal septicaemia) is suspected

Answer 6

give single dose of benzylpenicillin before hospital if this does not delay transfer

Question 7

what is initial empirical therapy for suspected bacterial meningitis WITHOUT non blanching RASH (plus alternatives)

Answer 7

• benzylpencillin before transfer

alternative in allergy: cefotaxime

if history of immediate hypersensitivity to penicillin or cephalosporins: chloramphenicol

Question 8

Treatment: in hospital

Answer 8

 Ceftriaxone/cefotaxime
 Often in combination with corticosteroids (dexamethasone)
 Depends on confirmed diagnosis.

Question 9

when giving dexamethasone, preferably start before or with first dose of abx, but no later than …. after starting abx

Answer 9

12 h

Question 10

in hospital consider adjunct treatment with dexamethasone esp if ….

Answer 10

pneumococcal meningitis suspected in adults

Question 11

avoid dexamethasone in the following (4)

Answer 11

septic shock
meningococcal septicaemia
immunocompromised
meningitis following surgery

Question 12

In hospital of aetiology unknown: adult and child 3 months - 59 yrs

Answer 12

cefotaxime or ceftriaxone

• consider vancomycin

10 days

Question 13

In hospital of aetiology unknown: adult 60 +

Answer 13

cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin)

consider vancomycin

10 days

Question 14

When would you consider vancomycin in meningitis

Answer 14

• 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

Question 15

Prevention

Answer 15

o HiB
o PCV
o MenC
o MenACWY