MENINGOCOCCAL MENINGITIS (THISIS ALL YOU NEED TO KNOW FOR PLAB 1… TRUST ME)
All patients should be transferred to hospital urgently. If patients are in a pre-hospital setting (for example a GP surgery) and meningococcal disease is suspected then intramuscular benzylpenicillin may be given, as long as this doesn’t delay transit to hospital.
Initial empirical therapy aged < 3 months Intravenous cefotaxime + amoxicillin
Initial empirical therapy aged 3 months - 50 years Intravenous cefotaxime
Initial empirical therapy aged > 50 years Intravenous cefotaxime + amoxicillin
Meningococcal meningitis Intravenous benzylpenicillin or cefotaxime
Pneuomococcal meningitis Intravenous cefotaxime
Meningitis caused by Haemophilus influenzae Intravenous cefotaxime
(NOTE THAT CEFOTAXIME APPEARS IN ALL SITUATIONS!!)
Management of contacts (VERY OFTEN ASKED IN EXAM)
• prophylaxis needs to be offered to household and close contacts of patients affected with meningococcal meningitis
• oral ciprofloxacin or rifampicin or may be used. The Health Protection Agency (HPA) guidelines now state that whilst either may be used ciprofloxacin is the drug of choice as it is widely available and only requires one dose
• the risk is highest in the first 7 days but persists for at least 4 weeks
• meningococcal vaccination should be offered to close contacts when serotype results are available, including booster doses to those who had the vaccine in infancy
• for pneumococcal meninigitis no prophylaxis is generally needed.