Canterbury DHB

Context

Meningitis - Adults

Pathogens

Drug Treatment

Empiric

ceftriaxone

HMLSchedNZFPMLnoids

IV 2 g every twelve hours

If risk of listeria (alcoholic, diabetic, > 50 years, pregnant, or immunosuppressed):

ADD

amoxicillin

HMLSchedNZFPMLnoids

IV 2 g every four hours

If risk of S. pneumoniae (known or suspected otitis media or sinusitis, recent treatment with a beta-lactam, Gram-positive cocci seen on Gram stain, or pneumococcal antigen assay of CSF is positive):

ADD

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines (use high doses).

Severe penicillin allergy

moxifloxacin

HMLSchedNZF

IV 400 mg every 24 hours (once a day)

Alternative regimen:

ciprofloxacin

HMLSchedNZFPMLnoids

IV 400 mg every eight hours

AND

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines (use high doses).

If risk of listeria (alcoholic, diabetic, > 50 years, pregnant, or immunosuppressed):

ADD

trimethoprim+sulfamethoxazole

HMLSchedNZFPMLnoids

(co-trimoxazole)

IV 5 mg/kg (trimethoprim component) every six hours (round dose down to the nearest whole vial)

Pathogens Known

S. pneumoniae

If susceptible to penicillin and the patient does not have a penicillin allergy:

benzylpenicillin

HMLSchedNZFPMLnoids

(Penicillin G)

IV 2.4 g (4 megaunits) every four hours

Mild penicillin allergy

ceftriaxone

HMLSchedNZFPMLnoids

IV 2 g every twelve hours

If resistant to penicillin or severe penicillin allergy:

vancomycin

HMLSchedNZFPMLnoids

See dosing guidelines (use high doses).

N. meningitidis (notifiable)

ceftriaxone

HMLSchedNZFPMLnoids

IV 2 g every twelve hours

Severe penicillin allergy

Consult Infectious Diseases/Clinical Microbiology

For clearance of nasopharyngeal N. meningitidis from patient and contacts:

ciprofloxacin

HMLSchedNZFPMLnoids

PO 500 mg single dose

OR

ceftriaxone

HMLSchedNZFPMLnoids

IM 250 mg single dose

Listeria monocytogenes (notifiable)

amoxicillin

HMLSchedNZFPMLnoids

IV 2 g every four hours

Penicillin allergy

trimethoprim+sulfamethoxazole

HMLSchedNZFPMLnoids

(co-trimoxazole)

IV 5 mg/kg (trimethoprim component) every six hours (round dose down to the nearest whole vial)

Information about this Canterbury DHB document (99219):

Document Owner:

Not assigned (see Who's Who)

Last Updated:

March 2018 (Central Nervous System)

Next Review Due:

March 2021

Keywords:

Note: Only the electronic version is controlled. Once printed, this is no longer a controlled document.

Topic Code: 99219