What is the treatment for suspected meningitis with symptoms of high fever, loss of appetite, vomiting, neck pain, and severe headache?

Treatment for Suspected Meningitis

Patients with suspected meningitis presenting with high fever, loss of appetite, vomiting, neck pain, and severe headache require immediate hospital admission via emergency ambulance for prompt evaluation, lumbar puncture, and empiric antibiotic therapy with ceftriaxone. 1

Clinical Recognition and Initial Management

• The symptoms described (high fever 104°F, loss of appetite, vomiting, neck pain, severe headache) are highly concerning for meningitis, though the classic triad of fever, neck stiffness, and altered mental status is present in less than 50% of bacterial meningitis cases 1, 2
• Urgent hospital referral is mandatory due to the possibility of rapid deterioration 1
• Rapid admission to hospital via emergency ambulance should be arranged with the goal of patient arrival within one hour of assessment 1
• Document presence or absence of headache, altered mental status, neck stiffness, fever, rash (of any description), seizures, and signs of shock 1
• Traditional Kernig's and Brudzinski's signs should not be relied upon for diagnosis as they have poor sensitivity (as low as 5%) 1

Hospital-Based Diagnostic Approach

• Lumbar puncture for cerebrospinal fluid (CSF) examination is essential for diagnosis when bacterial meningitis is suspected 1, 2
• Clinical features alone cannot distinguish between viral and bacterial meningitis; laboratory confirmation is necessary 1, 3
• Up to 95% of patients will have at least two of the following four cardinal symptoms: fever, nuchal rigidity, altered mental status, and headache 3

Treatment Protocol

• Empiric antibiotic therapy must be initiated immediately:

  • For adults: Ceftriaxone 2 grams IV every 12-24 hours (not to exceed 4 grams daily) 4
  • For meningitis specifically, the FDA-approved dosage is 100 mg/kg/day (not to exceed 4 grams daily), which can be administered once daily or in equally divided doses every 12 hours 4
  • The usual duration of therapy is 7-14 days 4

• Adjunctive therapy:

  • Dexamethasone should be administered with or just before the first dose of antibiotics 3
  • Management of elevated intracranial pressure may be necessary using established neurocritical care strategies 3

Causative Organisms and Antibiotic Coverage

• The most common bacterial causes in adults are Streptococcus pneumoniae and Neisseria meningitidis 4, 3
• Ceftriaxone provides coverage for the most common meningitis-causing pathogens including Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae 4
• If Listeria monocytogenes is suspected (more common in older adults), additional antibiotic coverage should be considered 1

Common Pitfalls to Avoid

• Delaying treatment while waiting for diagnostic confirmation - empiric antibiotics should be started immediately upon suspicion of bacterial meningitis 1
• Relying solely on the presence of classic symptoms - the absence of the classic triad does not rule out meningitis 2, 3
• Failing to recognize that clinical presentation may differ in specific populations (e.g., elderly patients are more likely to have altered consciousness and less likely to have neck stiffness or fever) 1
• Overlooking the possibility of meningococcal sepsis, which can occur with or without meningitis and requires the same urgent treatment approach 1

Prognosis and Complications

• Despite advances in treatment, bacterial meningitis remains associated with significant mortality (up to 20% for all causes and 30% for pneumococcal meningitis) 5
• Potential complications include sensorineural deafness, raised intracranial pressure, and other neurological sequelae 6
• Many patients experience fatigue, headaches, sleep disorders, and emotional problems in the weeks and months after discharge 5