In cases of suspected meningococcal meningitis/septicaemia antibiotics should be given immediately preferably before referral to hospital, and if in the hospital before lumbar puncture
Organism | Details | Antibiotic |
Streptococcus pneumonia | Main adult cause. Related to pneumococcal pneumonia, sinusitis, otitis media. Commoner in alcoholics, diabetes, post splenectomy complement deficiency and basal skull fractures and CSF rhinorrhoea | Penicillin G if sensitive. Ceftriaxone or cefotaxime initially. Vancomycin my be added. 2 week course |
Neisseria Meningitidis | Epidemics type A and C. Main cause in children and adolescents. Petechial non blanching rashes or purpura are vital to early diagnosis. Complement deficiencies e.g. properdin increase risk. Septicaemia - Waterhouse-Friederichsen syndrome with adrenal haemorrhage causing shock, DIC, haemorrhagic rash | Penicillin G if sensitive. Ceftriaxone, cefotaxime |
Haemophilus influenzae | reduced due to HiB vaccination | Cefotaxime or Ceftriaxone |
Gram negatives | seen in debilitated, diabetics and cirrhotics. Post craniotomy | Cefotaxime or Ceftriaxone. 3 week course |
Group B streptococci | Traditionally a neonatal infection. Now being seen in all ages including elderly | Penicillin G or Ampicillin |
Listeria monocytogenes | Seen in neonates and pregnant and immunocompromised and those over age 50. Foodborne - soft cheese, coleslaw and undercooked meats | Ampicillin for 3 weeks. Gentamicin may also be given |
Staphylococcal aureus | Seen following neurosurgical interventions eg CSF shunts, trauma, or underlying conditions, such as the following: Malignancy, leg ulcers , Cellulitis , Alcoholism, Diabetes, Osteomyelitis
| Vancomycin is drug of choice |
Cryptococcus neoformans | Immunocompromised patient
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