Management of Bacterial Meningitis Exposure
Immediate Infection Control and Isolation
All patients with suspected bacterial meningitis must be placed in respiratory isolation immediately upon presentation and remain isolated until meningococcal disease is excluded or they have received 24 hours of ceftriaxone or a single dose of ciprofloxacin. 1
Isolation Requirements
- Droplet precautions must be implemented, including nursing in a single room and wearing surgical masks when within 3 feet of the patient, until 24 hours of effective antibiotic therapy has been completed 1
- Patients with confirmed meningococcal meningitis or sepsis require barrier nursing until they have received 24 hours of IV ceftriaxone or a single dose of oral ciprofloxacin (or 48 hours of rifampicin) 1
- Other causes of bacterial meningitis (pneumococcal, Listeria) do not require isolation beyond standard precautions 1
Healthcare Worker Chemoprophylaxis
Antibiotic prophylaxis for healthcare workers is only indicated when there has been direct exposure to respiratory secretions or droplets from a patient with confirmed meningococcal disease. 1
Specific Indications for Prophylaxis
- High-risk exposures include mouth-to-mouth resuscitation, intubation, or close examination of the oropharynx without wearing a mask 1
- Standard patient care activities (routine examination, taking vital signs, administering medications) do NOT require prophylaxis 1
- The estimated risk for healthcare workers is 25 times greater than the general population but still extremely rare, with healthcare-associated infection being exceptionally uncommon 1
Prophylaxis Regimen
- Single dose ciprofloxacin 500-600 mg orally is the preferred regimen for eradication of meningococcal carriage 1, 2
- Alternative: Rifampicin 600 mg orally twice daily for 2 days 1
Close Contact Management
Close contacts of patients with confirmed meningococcal disease require chemoprophylaxis, defined as those who have had prolonged close contact (within 3 feet) or direct exposure to respiratory secretions. 1
Who Qualifies as a Close Contact
- Household members living with the patient 1
- Individuals who have had direct contact with the patient's oral secretions (kissing, sharing drinks/utensils) 1
- Healthcare workers with unprotected exposure to respiratory secretions as described above 1
Follow-Up Assessment
All patients who have been diagnosed with bacterial meningitis should be assessed for potential long-term sequelae before hospital discharge. 1
Required Assessments
- Hearing evaluation must be performed before discharge or within 4 weeks of being well enough to test if the clinician, patient, or family suspects hearing loss, or if the patient lacks capacity to report hearing changes 1
- The hearing test should be conducted by a hospital-based specialist 1
- Patients with severe to profound deafness should be offered fast-track assessment for cochlear implant 1
Neurological Sequelae to Document
- Cognitive deficits and learning impairment 1
- Epilepsy 1
- Movement disorders 1
- Visual disturbances 1
- Communication problems 1
Psychological Impact
- Emotional difficulties are well-documented after acquired brain injury from meningitis 1
- Early referral to mental health services should be considered, as viral and bacterial meningitis can cause significant morbidity and profound psychological impacts despite being treated 1
Common Pitfalls to Avoid
- Do not delay isolation while awaiting diagnostic confirmation—implement respiratory precautions immediately upon suspicion of meningococcal disease 1
- Do not provide unnecessary prophylaxis to healthcare workers who had standard patient contact without respiratory secretion exposure 1
- Do not discharge patients without documented hearing assessment if there is any concern for auditory complications 1
- Do not overlook psychological sequelae—bacterial meningitis survivors require assessment for both physical and emotional complications before discharge 1