Day 2 - Meningitis
Admit with Droplet precautions - Precautions can be discontinued after 24 hours of appropriate antimicrobial therapy
Absence of Classic Triad (Fever, neck stiffness, altered mental status) effectively rules out meningitis
Jolt Accentuation is the most sensitive finding to rule out meningitis
Kernig and Brudzinki’s signs have limited utility in diagnosing meningitis
Empiric* Drug Dosing:
Dexamethasone 0.15 - 0.20 mg/kg IV q6h
Give only PRIOR to antibiotics
Proven benefit in Streptococcal pneumonia meningitis only
Ceftriaxone 2g IV q12h
Vancomycin 25-30mg/kg x 1 loading dose, then Vancomycin 1g IV BID (may require renal dosing)
Check Vancomycin trough level pre-4th dose
Ampicillin 2g IV q4h
For Age > 50
Immunocompromised
Acyclovir 10-15mg/kg IV q6h
*Antibiotics should be tailored once organism is isolated and sensitivities established
Frequently Asked Questions:
Do I always need a CT head?
Not all patients require a CT head and therapy should not be delayed to obtain a CT head. However, any patient with focal neurological findings, or concern for elevated ICP should receive a CT head prior to a lumbar puncture to avoid herniation.
What if I can’t get a lumbar puncture?
Treatment should be initiated regardless of whether or not a lumbar puncture can be performed if suspicion for meningitis is high.
How do I treat aseptic meningitis?
CSF with leukocytosis but negative for culture can generally be treated supportively.
Empirically, all patients should be presumed to have bacterial meningitis until CSF results return to avoid delay in treatment.
What if antibiotics have been given but dexamethasone hasn’t?
There is no evidence for dexamethasone after antibiotics have already been administered
