Infection

Meningitis - pregnancy and adults ≥ 55 years old
Antibiotic Therapy (before prescribing, carefully read the Notes / Comments section below)

Ceftriaxone IV 2g 12 hourly

and

Amoxicillin IV 2g 4 hourly

If penicillin / beta-lactam anaphylaxis:

Chloramphenicol - follow Scottish Antimicrobial Prescribing Group guidance on chloramphenicol dosing.

and

Co-trimoxazole IV 1.44g 12 hourly

In pregnancy, the use of co-trimoxazole is contraindicated in the 1st trimester, and the use of chloramphenicol is contraindicated in the 3rd trimester - discuss appropriate empirical choices with an infection specialist. 
Duration

Depends on the causative organism

  • Neisseria meningitidis - 7 days
  • Streptococcus pneumoniae - 14 days
  • Listeria monocytogenes - 21 days
Notes / Comments
  • Neisseria meningitidis ("meningococcus") and Streptococcus pneumoniae are the most common causes of bacterial meningitis, but in states of immunocompromise (advancing age, pregnancy, iatrogenic immunosuppression), Listeria monocytogenes is a further potential cause.
  • Ceftriaxone and chloramphenicol provide reliable cover for N. meningitidis and S. pneumoniae, but do not cover L. monocytogenes, hence the addition of amoxicillin/co-trimoxazole respectively. 
  • If pneumococcal meningitis is suspected, consider adjunctive treatment with dexamethasone, preferably starting before or with first dose of antibacterial, but no later than 12 hours after starting antibacterial. Avoid dexamethasone in septic shock, meningococcal septicaemia, if immunocompromised or in meningitis following surgery.
  • Discuss management of suspected meningitis after neurosurgery with an infection specialist.

 

 

Guideline reviewed October 2023
Page updated October 2024



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