Meningitis
Infants:
Drowsiness
Fever
Poor feeding
Children:
Fever
Neck stiffness
Photophobia
Seizure
Organisms:
TB...
Neiserria
Strep pneumonia
Listeria
coag neg staph
Staph aureus
Hib
Gm neg bacilli
Salmonella enteritidis
Enterovirus: 71, poliovirus, coxsackievirus, echovirus
Herpes: HSV (most common), (CMV, VZV, HHV-6/7, EBV rarely)
Parecho
Influenza, mumps, zika, rabies
Ix
LP
Meningitis empiric:
<2mo Streptococcus agalactiae (group B strep), enteric Gram-negative rods or, rarely, Listeria monocytogenes
- Amp and cefotaxime +/- aciclovir
- cefotaxime (if critical add gent and vanc)
- continue if Streptococcus pneumoniae, Haemophilus influenzae type b, TB without HIV
- cease if meningococcal
Brain /sub dural abscess
Empiric: Metronidazole and cefotaxime/ceftriaxone
Post neurosurgery: Vancomycin and Meropenem
Immunocompromised: Bactrim IV and Meropenem
Epidural abscess:
Emperic: Fluclox and Gent
add Vanc if risk for MRSA
chemoprophylaxis
Neisseria meningitidis
- ciprofloxacin: <5y 30 mg/kg up to 125 mg, 5-12y 250 mg, >12y 500mg, orally, as a single dose
- rifampicin (neonate: 5mg/kg; child: 10 mg/kg up to 600 mg) orally, 12-hourly for 2 days.
- PREGNANCY > ceftriaxone 250 mg IM as single dose
- rifampicin (neonate: 10mg/kg; child: 20 mg/kg up to 600 mg) orally, daily for 4 days