Infection

Pre-hospital care of suspected meningitis or meningococcal septicaemia
Antibiotic Therapy (before prescribing, carefully read the Notes / Comments section below)

Benzylpenicillin IV or IM 1.2g for 1 dose

or

Cefotaxime IV or IM 2g for 1 dose. Intramuscular doses over 1g should be divided between more than one site.

If penicillin / beta-lactam allergy:

Chloramphenicol PO or IV 25mg/kg for one dose

In pregnancy, the use of chloramphenicol is contraindicated in the 3rd trimester - discuss appropriate empirical choices with an infection specialist.
Notes / Comments
  • Meningococcal disease in its early stages is difficult to diagnose because many of the features are non-specific and the classical manifestations of meningococcal diseases are uncommon in primary care.
  • Invasive meningococcal disease generally presents in three illness patterns:
    • Meningococcal septicaemia (approximately 20%): fever, petechiae, purpura and toxicity. Associated with a significantly poorer outcome.
    • Clinical meningitis:  fever, lethargy, vomiting, headache, photophobia, neck stiffness and positive Kernig’s and Brudzinski’s signs. These are the classic features of established bacterial meningitis of any cause. There may also be petechiae or purpura.
    • A mixed picture of septicaemia and meningitis.

 

 

Guideline reviewed October 2023
Page updated February 2024



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