The Center For Disease Dynamics, Economics & Policy

Acute Bacterial Meningitis (Community-Acquired)

Clinical definition:

Inflammation of meninges and subarachnoid space. Common symptoms include headache, fever, stiff neck, reduced consciousness. Major causes of bacterial meningitis include N. meningitidis, S. pneumoniae, L. monocytogenes.

 

Preferred antibiotic choice(s)
Drug Formulation Dosage Duration
Ceftriaxone (IV) Powder for injection: 250 mg; 1 g (as sodium salt) in vial 2 g 12 hourly If culture negative: 10 days. In case of proven S. pneumoniae infection: 14 days
Cefotaxime (IV) Powder for injection: 250 mg per vial (as sodium salt 2 g 6 hourly
Alternative antibiotic choice(s)
Ampicillin (IV) Powder for injection: 500 mg; 1 g (as sodium salt) in vial 3 g 6 hourly 10 days, or if confirmed L. monocytogenes: 3 weeks
Benzylpenicillin (IV) Powder for injection: 600 mg; 3 g (sodium or potassium salt) in vial 4 MU 4 hourly 10 days
Chloramphenicol (IV)A Powder for injection: 1 g (sodium succinate) in vial 1 g 6 hourly 10 days
In case of non-severe penicillin allergy
Ceftriaxone Powder for injection: 250 mg; 1 g (as sodium salt) in vial 2 g 12 hourly If culture negative: 10 days. In case of proven S. pneumoniae infection: 14 days
Cefotaxime (IV) Powder for injection: 250 mg per vial (as sodium salt 2 g 6 hourly
In case of severe Penicillin allergy
Moxifloxacin (IV, PO) Tablet: 400 mg or 100 mg (dispersible); Injectable solution: 400mg/250 mL 400 mg once daily If culture negative: 10 days. In case of proven S. pneumoniae infection: 14 days

 

A. Chloramphenicol is not preferred and should only be used if other listed antibiotics are not available.

 

Principles of Stewardship:

  • Acute meningitis may be caused by a range of pathogens, some of which are not bacteria. Microbiologic diagnosis, including bacterial culture from CSF and blood, should be obtained as soon as possible to confirm etiology.
  • In presentations of subacute or chronic nature, consider diagnostic tests for TB meningitis, particularly in HIV-endemic areas.

Notes:

  • Add ampicillin in situations of confirmed Listeria outbreaks and for patients at high risk for Listeria including:
    • Patients over 50 years of age
    • Immunosuppressed patients – cancer, transplantation etc.
    • Patients with alcoholism, cirrhosis, etc.
    • Pregnant women