Meningitis

Summary of changes

Addition

  • 4 symptoms for adults (headache, fever, stiff neck,  altered mental status) when considering if meningitis
  • POC test for WBC to blood cultures and throat swab
  • Medical consult re dexamethasone if child under 2mths

Deletion

  • Positive Kernig's sign 

Medicines

  • Changed ceftriaxone dose for child (from 4g to up to 2g)
  • Expression of dexamethasone dose from dexamethasone IV single dose – 0.15mg/kg/dose
    to dexamethasone IV single dose – adult 10 mg, child: 0.15 mg/kg up to 10 mg
  • Ceftriaxone dose from ceftriaxone IV single dose – adult 4g, child 100mg/kg/dose up to 4g
    to ceftriaxone IV single dose – adult 4g, child 50mg/kg/dose up to 2g 

Other

  • Order to give antibiotics before steroids

Primary references

  1. Attia J, Hatala R, Cook DJ and Wong JG (1999) 'The rational clinical examination. Does this adult patient have acute meningitis?', Journal of the American Medical Association, 282(2):175-81, doi:10.1001/jama.282.2.175

  2. Beaman MH (2018) 'Community-acquired acute meningitis and encephalitis: a narrative review', Medical Journal of Australia, 209(10), doi:10.5694/mja17.01073

  3. Expert Groups for Antibiotic, version 16 (2021) Antibiotic, Therapeutic Guidelines, accessed 21 May 2021.

  4. The Royal Children’s Hospital Melbourne (2020) Meningitis-Encephalitis, Clinical Practice Guidelines, accessed 11 January 2022.

  5. van de Beek D, de Gans J, Spanjaard L, Weisfelt M, Reitsma JB and Vermeulen M (2004) 'Clinical features and prognostic factors in adults with bacterial meningitis', New England Journal of Medicine, 351(18):1849-59, doi:10.1056/NEJMoa040845