17/03/2023
Bacterial Meningitis in Adults
Treatment Algorithm
Initial
Suspected bacterial Meningitis
0.5 mL/kg/hour (a urinary catheter is required).
Lactate: 0.5 mL/kg/hour (a urinary catheter is required).
Lactate: 96%) in acutely ill adults is associated with higher mortality than more conservative oxygen therapy. [85]
A lower target SpO2 of 88% to 92% is appropriate if the patient is at risk of hypercapnic respiratory failure. [84]
Fluid management
Give crystalloid fluids to maintain normal haemodynamic parameters. [15]
Normal blood pressure for age in adults: ≥65 mmHg mean arterial pressure.
Urine output: >0.5 mL/kg/hour (a urinary catheter is required).
Lactate: 96%) in acutely ill adults is associated with higher mortality than more conservative oxygen therapy. [85]
A lower target SpO2 of 88% to 92% is appropriate if the patient is at risk of hypercapnic respiratory failure. [84]
Fluid management
Give crystalloid fluids to maintain normal haemodynamic parameters. [15]
Normal blood pressure for age in adults: ≥65 mmHg mean arterial pressure.
Urine output: >0.5 mL/kg/hour (a urinary catheter is required).
Lactate: 96%) in acutely ill adults is associated with higher mortality than more conservative oxygen therapy. [85]
A lower target SpO2 of 88% to 92% is appropriate if the patient is at risk of hypercapnic respiratory failure. [84]
Fluid management
Give crystalloid fluids to maintain normal haemodynamic parameters. [15]
Normal blood pressure for age in adults: ≥65 mmHg mean arterial pressure.
Urine output: >0.5 mL/kg/hour (a urinary catheter is required).
Lactate: 96%) in acutely ill adults is associated with higher mortality than more conservative oxygen therapy. [85]
A lower target SpO2 of 88% to 92% is appropriate if the patient is at risk of hypercapnic respiratory failure. [84]
Fluid management
Give crystalloid fluids to maintain normal haemodynamic parameters. [15]
Normal blood pressure for age in adults: ≥65 mmHg mean arterial pressure.
Urine output: >0.5 mL/kg/hour (a urinary catheter is required).
Lactate: 2 micrograms/mL) or in cases of contraindications to vancomycin, give linezolid with or without rifampicin. [24]
Stop dexamethasone. [15]
Consider other sites of infection, such as spinal epidural abscesses or endocarditis, which may require surgical intervention and prolonged antibiotic therapy. [24]
Consider narrowing pathogen-specific treatment further, if appropriate, once the results of sensitivity testing are available or following consultation with a microbiologist.
If you discharge a patient from hospital, prescribe oral antibiotics to complete the full duration of the antibiotic course according to culture sensitivity results.
Treatment duration: at least 14 days.
Primary options
Non-MRSA penicillin-sensitive
flucloxacillin2 g intravenously every 6 hours
OR
Non-MRSA penicillin-sensitive
flucloxacillinflucloxacillin: 2 g intravenously every 6 hours
-- AND --
rifampicin600 mg intravenously/orally every 12 hours
or
fosfomycin16–24 g/day intravenously given in divided doses every 6-8 hours, maximum 8 g/dose
Secondary options
Penicillin-allergic
vancomycin15-20 mg/kg intravenously every 8-12 hours
or
linezolid600 mg intravenously every 12 hours
-- AND --
rifampicin600 mg intravenously/orally every 12 hours
or
fosfomycin6–24 g/day intravenously given in divided doses every 6-8 hours, maximum 8 g/dose
Tertiary options
MRSA - vancomycin-sensitive
vancomycin15-20 mg/kg intravenously every 8-12 hours
OR
MRSA - vancomycin-sensitive
vancomycin15-20 mg/kg intravenously every 8-12 hours
and
rifampicin600 mg intravenously/orally every 12 hours
OR
MRSA - vancomycin-resistant or contraindicated
linezolid600 mg intravenously every 12 hours
OR
MRSA - vancomycin-resistant or contraindicated
linezolid600 mg intravenously every 12 hours
and
rifampicin600 mg intravenously/orally every 12 hours
plus: supportive care
Treatment recommended for ALL patients in selected patient group
In practice, monitor the patient for deterioration.
Seek advice from a senior clinical decision-maker if signs develop suggesting the need for intubation or management of raised intracranial pressure.
[Video: Bag-valve-mask ventilation animated demonstration][Video: Tracheal intubation animated demonstration]
Oxygen
Give high-flow oxygen and aim for a target oxygen saturation of 94% to 96% in acutely ill patients who are not at risk of hypercapnia. [16] [28] [84]
Latest evidence suggests that liberal use of supplemental oxygen (target SpO2 >96%) in acutely ill adults is associated with higher mortality than more conservative oxygen therapy. [85]
A lower target SpO2 of 88% to 92% is appropriate if the patient is at risk of hypercapnic respiratory failure. [84]
Fluid management
Give crystalloid fluids to maintain normal haemodynamic parameters. [15]
Normal blood pressure for age in adults: ≥65 mmHg mean arterial pressure.
Urine output: >0.5 mL/kg/hour (a urinary catheter is required).
Lactate: 96%) in acutely ill adults is associated with higher mortality than more conservative oxygen therapy. [85]
A lower target SpO2 of 88% to 92% is appropriate if the patient is at risk of hypercapnic respiratory failure. [84]
Fluid management
Give crystalloid fluids to maintain normal haemodynamic parameters. [15]
Normal blood pressure for age in adults: ≥65 mmHg mean arterial pressure.
Urine output: >0.5 mL/kg/hour (a urinary catheter is required).
Lactate:
