From the Guidelines
Meningitis requires immediate medical attention, and for suspected bacterial meningitis, empiric antibiotic therapy should be started within one hour of arrival, with the choice of antibiotics depending on the patient's age, risk factors, and local resistance rates of pneumococci, as recommended by the European Society of Clinical Microbiology and Infectious Diseases 1.
Symptoms of Meningitis
Meningitis presents with fever, headache, neck stiffness, photophobia, altered mental status, and sometimes a rash. The clinical characteristics and laboratory parameters are of limited diagnostic accuracy, and cerebrospinal fluid analysis remains the principal contributor to the final diagnosis 1.
Management of Meningitis
Management depends on whether it's bacterial, viral, or fungal. For suspected bacterial meningitis, immediate empiric antibiotic therapy is crucial, and dexamethasone is the only proven adjunctive treatment and should be started together with the antibiotics 1. Viral meningitis is usually self-limiting, requiring supportive care with fluids, rest, and pain management. Fungal meningitis requires antifungal medications like amphotericin B.
Prevention and Follow-up
Prevention includes vaccination against common causative organisms like pneumococcus, meningococcus, and Haemophilus influenzae type b. The follow-up of surviving patients should include evaluation for hearing loss and pneumococcal vaccination to prevent recurrences 1.
Key Considerations
The incidence of bacterial meningitis has decreased following pneumococcal and meningococcal conjugate vaccine introduction, but the disease remains life-threatening if untreated, causing brain damage, hearing loss, or death due to the rapid spread of infection in the cerebrospinal fluid surrounding the brain and spinal cord 1.
From the FDA Drug Label
MENINGITIS Caused by Haemophilus influenzae, Neisseria meningitidis or Streptococcus pneumoniae Ceftriaxone for Injection has also been used successfully in a limited number of cases of meningitis and shunt infection caused by Staphylococcus epidermidis1 and Escherichia coli.
The symptoms of meningitis are not directly mentioned in the provided drug labels. However, the management of meningitis is mentioned as being treatable with ceftriaxone, with a recommended initial therapeutic dose of 100 mg/kg (not to exceed 4 grams) 2.
- The daily dose may be administered once a day (or in equally divided doses every 12 hours).
- The usual duration of therapy is 7 to 14 days. It is essential to note that these recommendations are based on the treatment of meningitis caused by susceptible organisms, and the specific symptoms and management may vary depending on the causative organism and individual patient factors.
From the Research
Symptoms of Meningitis
- The symptoms of meningitis can vary depending on the cause, but common symptoms include headache, fever, stiff neck, and confusion 3
- In some cases, patients may experience seizures, vomiting, and loss of appetite 3
Management of Meningitis
- The management of meningitis typically involves the use of antibiotics, such as ceftriaxone or cefotaxime, to treat bacterial meningitis 4, 5
- Ceftriaxone is effective in treating bacterial meningitis in infants and children, but it is not recommended in neonates due to concerns about bilirubin displacement 4
- In adults, ceftriaxone is effective therapy for presumed bacterial meningitis, but it must be combined with ampicillin initially to cover for L. monocytogenes meningitis 4
- Lumbar puncture and cerebrospinal fluid analysis are critical components of the diagnosis and management of meningitis 3, 6
- Repeated therapeutic lumbar punctures may be necessary in some cases, such as cryptococcal meningitis, to manage raised intracranial pressure and to monitor treatment response 7
Diagnostic Techniques
- Diagnostic lumbar punctures can be performed using atraumatic needles, which may decrease the risk of headache after the procedure 6
- Reinsertion of the stylet before needle removal can also decrease the risk of headache 6
- Patients do not require bed rest after the procedure, and mobilization after lumbar puncture does not appear to increase the risk of headache 6
- Biochemical analysis of cerebrospinal fluid, including glucose ratio, white blood cell count, and lactate level, can help diagnose bacterial meningitis 6