From the Guidelines
Patients with suspected meningitis should be respiratory isolated and have droplet precautions taken until meningococcal meningitis or sepsis is excluded, or they have received 24 h of Ceftriaxone or a single dose of Ciprofloxacin. This is based on the most recent and highest quality study available, which provides guidelines for the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1.
Key Precautions
- Respiratory isolation should be implemented for all patients with suspected meningitis or meningococcal sepsis until the diagnosis is excluded or they have received appropriate antibiotic treatment 1.
- Droplet precautions, including the wearing of surgical masks, should be taken until a patient has had 24 h of antibiotics 1.
- Antibiotic chemoprophylaxis should be given to healthcare workers who have been in close contact with a patient with confirmed meningococcal disease, particularly when exposed to their respiratory secretions or droplets 1.
Additional Considerations
- The use of Ceftriaxone or Ciprofloxacin as part of the treatment regimen can help reduce the risk of transmission to others 1.
- It is essential to follow proper infection control procedures, including the use of personal protective equipment (PPE), to minimize the risk of transmission to healthcare workers and others 1.
- The guidelines emphasize the importance of prompt initiation of antibiotic therapy and isolation precautions to prevent the spread of meningococcal disease 1.
From the Research
Contagion Precautions for Suspected Meningitis
- The primary concern in managing a patient with suspected meningitis is to prevent the spread of the disease, particularly if it is caused by a contagious pathogen like Neisseria meningitidis 2, 3, 4.
- Chemoprophylaxis is considered for close contacts of individuals with meningococcal infections, as they are at a higher risk of contracting the disease 2, 3, 4.
- Antibiotics such as ciprofloxacin, rifampin, and ceftriaxone have been shown to be effective in eradicating Neisseria meningitidis from the pharynx of healthy carriers and preventing secondary cases of meningococcal disease 2, 3.
- Vaccination against common pathogens that cause bacterial meningitis is also recommended as a preventative measure 5, 4.
- In cases where meningitis is suspected, empiric antibiotic therapy should be initiated promptly, and the choice of antibiotics should be guided by the patient's age, risk factors, and local resistance patterns 5, 6.
- Dexamethasone should be administered to children and adults with suspected bacterial meningitis before or at the time of initiation of antibiotics 5, 6.
Specific Precautions for Healthcare Workers
- Healthcare workers should take precautions when interacting with patients who have suspected meningitis, including wearing personal protective equipment (PPE) such as masks and gloves 6.
- Lumbar puncture should be performed safely, and empiric therapy should be started immediately after the procedure 6.
- If clinical signs suggest a contraindication for lumbar puncture, such as severely decreased consciousness or new onset focal neurological signs, cerebral imaging should be performed before the procedure 6.
Prevention of Secondary Cases
- Chemoprophylaxis should be offered to close contacts of individuals with meningococcal infections, particularly in households or other settings where the risk of transmission is high 2, 3, 4.
- Vaccination can also be an effective way to prevent secondary cases of meningococcal disease, especially in populations with high carriage rates 2, 3, 4.