Treatment should not be delayed pending investigations.
Specimens for collection:
Blood: for culture, glucose and EDTA blood for meningococcal & pneumococcal PCR
CSF: for microscopy and culture, glucose estimation and PCR
Throat swab for culture: labelled ‘? N. meningitidis’.
Once pathogen is identified, treatment should be tailored to the narrowest spectrum agent that is sensitive. Seek microbiology advice.
Bacterial meningitis is a notifiable disease. Inform Public Health: They will advise on chemoprophylaxis
Outside of normal working hours advice on chemoprophylaxis for contacts of meningococcal disease can be obtained from the emergency Public Health Advisory Service (ambulance control).
Chemoprophylaxis is indicated only for those who had close prolonged cantact with the case in the preceding seven days:
shared living/sleeping accommodation with case
were mouth kissing contacts
were nursery/crèche contacts
were boarding school dormitory contacts
Casual contacts, e.g. school classmates, playmates and neighbours are generally not considered to need chemoprophylaxis. Seek advice from Public Health or microbiology if unsure.
Unless the index case has received ceftriaxone in hospital, chemoprophylaxis should also be given to the patient prior to discharge. When the disease has been treated with cefotaxime it may be prudent to give chemoprophylaxis until studies are available on its effectiveness in eradicating carriage.
Chemoprophylaxis is recommended only for healthcare workers whose mouth ort nose is directly exposed to large particle droplets/secretions from the respiratory tract of a probable or confirmed case of meningococcal mdisease during the actue illness until the case has completed 24 hours of antibiotics. Thsi type of contact will only occur among staff who are working close to teh face of a case without wearing a mask or other mechanical protection. In practice this implies a clear perception of pacial contact with droplets/secretions and is unlikely to occur unless using suction during airway management, inserting an airway, intubating or is the patient coughs in your face. General medical or nursing care of cases is not an indication for prophylaxis.
CUH Emergency Department
Meningitis prophylaxis drugs are kept in a box in the DDA press in the clean utility room. These are supplied by public health but include rifampicin liquid & capsules. These may be supplied to family contacts, staff etc out of hours as indicated above.
If Haemophilus influenzae type b, pneumococcal meningitis or Neisseria meningitidis Groups C, A, Y and W135, vaccination of contacts and index may be indicated. Please refer to Public Health for advice.
Antibiotics for preventing meningococcal infections.
** Moxifloxacin is contraindicated in clinically relevant heart failure with ↓ ventricular ejection fraction, in bradycardia, QT prolongation or history of symptomatic arrhythmias.
Moxifloxacin should not be used concurrently with other drugs that prolong the QT interval, e.g. amiodarone, sotalol, neuroleptics e.g. haloperidol, chlorpromazine.
Seek advice from pharmacy. It is also contraindicated in patients with impaired liver function (Child Pugh C).
Prophylaxis drugs - CUH
Meningitis prophylaxis drugs (plus info) are kept in a box in the DDA press in the clean utility room. These are supplied by public health but it includes rifampicin liquid & capsules. These may be supplied to family contacts, staff etc out of hours.