Any patient who presents with symptoms/signs of meningitis should undergo a lumbar puncture (LP) and immediately begin empirical antibiotic therapy while pending LP results for culture and examination. However, A CT scan is mandatory before LP if there's a history of focal signs, altered sensorium, seizures or intracranial mass to avoid herniation.
Empirical AB therapy is as follows:
-Neonates: cefotaxime + ampicillin
-Older children & adults: ceftriaxone + vancomycin
-Immunosuppressed: ceftriaxone + vancomycin + ampicillin
-Post-neurosurgery, hospital acquired meningitis, head injury &
CSF shunt: ceftazidime + vancomycin
Once results are obtained:
-Streptococcal: ceftriaxone + vancomycin
-Meningococcal: penicillin G, ceftriaxone, rifampicin
-H.influenza: ceftriaxone, cefotaxime
-Staphylococcal: Methicillin-sensitive: naficillin or oxacillin. MRSA/S.epidermidis: vancomycin
-Cryptococcal: IV Amphotericin B for 14 days and oral fluconazole in HIV for life
-TB: Rif+INH+PTB+ETB or STM for 2 months and then Rif+INH for the next 4 months.
-Viral meningoencephalitis: IV Aciclovir for 10 days.
STEROIDS are important in H.flu, children, TB meningitis & TB serositis.
Ampicillin is added whenever possible to cover Listeria which is common in neonates, elderly & immunocompromised persons.
Penicillin-allergic patients can take chloramphenicol.
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