By Dr Ananya Mandal, MD
Those with meningitis, especially due to bacterial causes, have a high risk of blood infection or septicaemia. Immediate hospital admission is required for these patients.
Treatment of bacterial meningitis
- Urgent hospital admission. With severe infections, treatment in the intensive care unit (ICU) is recommended.
- Diagnosis of the causative organism is made. Specific bacteria and its sensitivity to antibiotics needs to be determined before targeted antibiotics may be given.
- Antibiotics are used to treat the infection. Initial empirical or “blind” antibiotics are begun without delay and these may be continued or changed to a more specific antibiotic once the causative organism is confirmed by laboratory tests. The antibiotics are commonly given via injections into a vein over the forearm.
- Blind antibiotic therapy includes third generation cephalosporins like cefotaxime or ceftriaxone and Amoxicillin if listeriosis is suspected.
- Benzylpenicillin is given if meningococcal infection is suspected (usually for 7 days) and Rifampicin or ciprofloxacin for 2 days if nasal colonization is suspected.
- Meningitis suspected to be caused by pneumococci or hemophilis influenza type b needs cefotaxime for 10-14 days or benzylepenicillin. Rifampicin is usually given for four days prior to discharge for patients with hemophillus infections.
- Benzylpenicillin and gentamicin, or cefotaxime alone are given for 14 days for meningitis caused by group B streptococcal infections.
- In addition Amoxicillin and gentamicin for 10-14 days are usually given for listeriosis.
- Vital support including oxygen, intravenous fluids, nutritional support etc. need to be begun upon admission.
- Corticosteroids are administered to reduce the edema, swelling and inflammation of the meninges. Steroids like dexamethasone have shown to prevent hearing loss and other complications of meningitis. Dexamethasone or a similar corticosteroid needs to be started just before the first dose of antibiotics is given, and continued for four days.
- General measures such as anti-emetics for the nausea and vomiting and anti-seizure medications or anticonvulsants for seizures are recommended.
- Usually a week or so of hospital stay is needed if the patient responds well to antibiotics. Those with more severe illness may need to stay in the hospital longer.
Treatment of viral meningitis
- Severe viral meningitis requires hospital admission.
- Treatment is begun with vital support with oxygen and intravenous fluids and antibiotics.
- Once diagnosis is made and causative virus identified, antibiotics are withdrawn since they are infective against viruses. However, intravenous fluids will be continued.
- Some severe infections may require antiviral medications. Aciclovir is considered beneficial in treating herpetic viral infections but only if given very early in the course of the infection. Patients need to be given Aciclovir injections immediately if there is suspicion of herpes encephalitis or brain infection. Ganciclovir is effective for cytomegalovirus (CMV) infections.
- Those with a mild viral meningitis will not require hospital treatment. These patients need bed rest, plenty of fluids and painkillers for headache and anti-emetics for nausea and vomiting.
- Recovery is usually within a week or two
Reviewed by April Cashin-Garbutt, BA Hons (Cantab)