From the Guidelines
Meningitis symptoms include fever, headache, neck stiffness, sensitivity to light, confusion, nausea, and vomiting, and treatment should be initiated immediately with empiric antibiotics, such as ceftriaxone or vancomycin, within one hour of arrival, as advised by the ESCMID guideline 1.
Symptoms of Meningitis
The symptoms of meningitis can vary, but common signs include:
- Fever
- Headache
- Neck stiffness
- Sensitivity to light
- Confusion
- Nausea
- Vomiting These symptoms can be present in various combinations, and no single symptom is universally present in all patients 1.
Treatment of Meningitis
Treatment of meningitis depends on the cause, with bacterial meningitis requiring immediate intravenous antibiotics, such as ceftriaxone (2g IV every 12 hours) or vancomycin (15-20 mg/kg IV every 8-12 hours), for 7-14 days 1.
- Viral meningitis typically resolves on its own with supportive care, including rest, fluids, and pain relievers.
- Fungal meningitis requires antifungal medications, such as amphotericin B (0.7-1.0 mg/kg/day IV), for several weeks.
- Corticosteroids, like dexamethasone (0.15 mg/kg IV every 6 hours for 2-4 days), may be given to reduce inflammation and prevent complications, as recommended by the ESCMID guideline 1.
Importance of Prompt Diagnosis and Treatment
Prompt diagnosis through lumbar puncture (spinal tap) is crucial for determining the specific cause and appropriate treatment of meningitis 1.
- Delayed treatment can lead to serious complications, including brain damage, hearing loss, or death.
- The ESCMID guideline advises starting empiric treatment within one hour of arrival in all suspected meningitis cases, irrespective of cranial imaging before lumbar puncture 1.
From the FDA Drug Label
MENINGITIS Caused by Haemophilus influenzae, Neisseria meningitidis or Streptococcus pneumoniae Central nervous system infections, e.g., meningitis and ventriculitis, caused by Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, Klebsiella pneumoniae* and Escherichia coli*.
The symptoms of meningitis are not explicitly stated in the provided drug labels. However, the labels do mention that ceftriaxone and cefotaxime are indicated for the treatment of meningitis caused by certain susceptible organisms.
- Treatment of meningitis may include the use of antibiotics such as ceftriaxone 2 or cefotaxime 3.
- The causative organisms of meningitis that may be treated with these antibiotics include:
- Haemophilus influenzae
- Neisseria meningitidis
- Streptococcus pneumoniae
- Klebsiella pneumoniae
- Escherichia coli
From the Research
Meningitis Symptoms
- The classic triad of neck stiffness, fever, and altered consciousness is present in less than 50% of cases of bacterial meningitis 4
- Patients with viral meningitis also present with signs of meningism (headache, neck stiffness, and photophobia) possibly with additional non-specific symptoms such as diarrhea or sore throat 4
- Other symptoms may include:
- Photophobia
- Seizures
- Vomiting
- Confusion
- Disorientation
Meningitis Treatment
- Antibiotic therapy for suspected acute bacterial meningitis (ABM) needs to be started immediately, even before the results of cerebrospinal fluid (CSF) culture and antibiotic sensitivity are available 5
- Third-generation cephalosporins, such as ceftriaxone or cefotaxime, are effective antibiotics for the treatment of bacterial meningitis 6, 7, 5, 8
- Ceftriaxone can be administered once daily, with a dose of 100 mg/kg/day intravenously 7, 8
- The treatment duration is typically 7-10 days, but may vary depending on the causative organism and the patient's response to treatment 6, 8
- Conventional antibiotics, such as ampicillin or chloramphenicol, may also be used as alternatives, especially in situations where third-generation cephalosporins are not available or affordable 5