This document discusses bacterial meningitis, including common causative bacteria by age, clinical signs and symptoms, diagnosis, treatment, and prevention. Bacterial meningitis is a medical emergency requiring prompt antibiotic therapy. Empiric therapy choices are based on patient age and suspected pathogens. Prevention involves vaccination against common causes such as Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae type B. Personal hygiene and vaccination are important for preventing the spread of bacterial meningitis.

1. Seek light

2. BACTERIAL MENINGITIS
Inflammation of
meninges, particularly
arachnoid and pia mater
associated with invasion
of bacteria into sub
arachnoid space.

3. COMMON BACTERIAs…
Premature /Neonates (<3 months)
Group B streptococci
Gram –ve enterics
Listeria monocytogenes
Children <5 years
Haemophilus influenzae B
Neisseria meningitidis
Streptococcus pneumoniae
Adults
N.meningitidis
S.pneumoniae (80% cases)
L.monocytogenes(Risk> 50 yrs)

4. CLINICAL SIGNS

5. CLINICAL SYMPTOMS

6. BACTERIAL
MENINGITIS
SCORE

7. Bacterial meningitis is a neurologic emergency

Antimicrobial therapy as soon as possible
(Must continue 48-72 hrs as empirical )

Choice of agents for empiric therapy determined by the
 patient’s age
 presence of predisposing conditions
 antimicrobial resistance
 Antimicrobial therapy should be modified as soon as the pathogen has been
isolated and in vitro tests have been performed

8. EMPIRICAL THERAPY BASED ON AGE AND
PATHOGENS
Less than 1 month
S.agalactiae (GBS)
Gram –ve enterics
L.monocytogenes
Ampicillin + Cefotaxime
OR
Ampicillin + Aminoglycoside

9. 1-23 months
S.pneumoniae
N.meningitidis
H.influenzae
S.agalactiae
Vancomycin + 3rd generation cephalosporin
(cefotaxime/ceftriaxone)

10. 2 years – 50 years
N.meningitidis
S.pneumoniae
Vancomycin + 3rd generation cephalosporin
(cefotaxime/ceftriaxone)

11. Above 50 years
N.meningitidis
S.Pneumoniae
Gram –ve enterics
L.monocytogenes
Vancomycin + 3rd generation cephalosporin
(cefotaxime/ceftriaxone)

12. GRAM +VE ORGANISMS
CONSIDERATIONS ANTIBIOTIC 1ST
CHOICE
ALTERNATIVE DURATION
Penicillin sensitive Penicillin G
(4 million units q4hr)
OR
Ampicillin
(2g q 4hrs)
Cefotaxime
( 2g q4-6 hr)
OR
Ceftriaxone
(2g q4-6hr)
10 to 14
days
Penicillin resistant Vancomycin
(15-20mg/kg q8-
12hr)
+
Cefotaxime
/Ceftriaxone
Moxifloxacin
(2g q8hr)
Ceftriaxone
resistant
Vancomycin +
Cefotaxime
Moxifloxacin
Streptococcus
pneumoniae
NOTE- Adult dose
is given here.

13. GRAM +VE ORGANISMS
CONSIDERATIONS ANTIBIOTIC 1ST
CHOICE
ALTERNATIVE DURATION
Methicillin
sensitive
Nafcillin OR
Oxacillin
(2g q4hr)
Vancomycin
OR
Meropenam
(2g q8hr)
14 to 21
days
Methicillin
resistant
Vancomycin TMP-SMX
(5mg/kg q6-12hr)
OR
Linezolid(600mg q12
hr)
Staphylococcus
aureus

14. GRAM +VE ORGANISMS
ANTIBIOTIC 1ST
CHOICE
ALTERNATIVE DURATION
Penicillin G
OR
Ampicillin
+/- Gentamicin
(2mg/kg q8hr)
Cefotaxime
OR
Ceftriaxone
14 to 21 days
Group B
streptococcus

15. GRAM +VE ORGANISMS
ANTIBIOTIC 1ST
CHOICE
ALTERNATIVE DURATION
Vancomycin
(15-20mg/kg q8-
12hr)
Linezolid
(600 mg q 12hr)
14 to 21 days
Staphylococcus
epidermidis

16. GRAM +VE ORGANISMS
ANTIBIOTIC 1ST
CHOICE
ALTERNATIVE DURATION
Penicillin G
OR
Ampicillin
+/- Gentamicin
(2mg/kg q8hr)
TMP-SMX
OR
Meropenam
> 21 days
Listeria
monocytogenes

17. GRAM -VE ORGANISMS
Neisseria
meningitidis
CONSIDERATIONS ANTIBIOTIC 1ST
CHOICE
ALTERNATIVE DURATIO
N
Penicillin
sensitive
Penicillin G
(4 million units
q4hr)
OR
Ampicillin
(2g q 4hrs)
Cefotaxime
( 2g q4-6 hr)
OR
Ceftriaxone
(2g q4-6hr)
7 to 10
days
Penicillin
resistant
Cefotaxime
OR
Ceftriaxone
Meropenam
OR
Moxifloxacin

18. GRAM -VE ORGANISMS
Haemophilus
influenzae
CONSIDERATIONS ANTIBIOTIC 1ST
CHOICE
ALTERNATIVE DURATION
Beta lactamase
negative
Ampicillin
(2g q 4hrs)
Cefotaxime
( 2g q4-6 hr)
OR
Ceftriaxone
(2g q4-6hr)
7 to 10
days
Beta lactamase
positive
Cefotaxime
OR
Ceftriaxone
Cefepime
OR
Moxifloxacin

19. GRAM -VE ORGANISMS
ANTIBIOTIC 1ST
CHOICE ALTERNATIVE DURATION
Cefotaxime
OR
Ceftriaxone
Cefepime,Moxifloxacin,
Aztreonam
OR
Meropenam
21 days
Enterobacteriaceae

20. GRAM -VE ORGANISMS
ANTIBIOTIC 1ST
CHOICE ALTERNATIVE DURATION
Cefepime
OR
Ceftazidime
+/-
Tobramycin
Ciprofloxaicn,Meropenam,
Piperacillin + Tobramycin,
Colistin,aztreonam
21 days
Pseudomonas
aeruginosa

21. • Administer IV fluids
• half-normal saline (0.45%) and 5% dextrose at 100% of normal maintenance
volumes for the 1st 48 hrs of treatment.
• Antipyretics for fever (Paracetamol 650 mg q4-6hrs )
• Dexamethasone adjuvant for pediatric meningitis (H.influenzae)
It should be given 0.15 mg/kg q6hr 2-4 days 10-20 mins before or with antibiotic.
Moniter GI bleeding symptoms and hyperglycemia
Prophylaxis
• Rifampicin 600mg IV OD ( also given in combination with 3rd generation ceph
with or without vancomycin)
• Ceftriaxone 1-2g IV q24hr + Azithromycin 1g OD
• Ciprofloxacin OR Azithromycin 500mg

22. VACCINATIONS
• There are vaccines for three types of bacteria that can cause meningitis:
• Neisseria meningitidis
• Meningococcal conjugate or MenACWY vaccines
• Serogroup B meningococcal or MenB vaccines
• Streptococcus pneumonia
• Pneumococcal conjugate vaccine
• Pneumococcal polysaccharide vaccine
• Haemophilus influenzae type b (Hib)
• Hib vaccine

23. PREVENTION

24. KEY POINTS
Bacterial meningitis is medical emergency requiring antibiotic therapy as soon as
possible
Choice of drug – Cefotaxime or Ceftriaxone (common)
Contagious , spread through nasal and throat secretions
Incubation period of meningococcal meningitis is 3-4 days (Range of 2-10 days )
Inflammation of meninges permit entry of antibiotics in CSF
Children and Adults can prevent infection through vaccinations
Maintain personal hygiene

25. REFERENCES
• https://www.vaccines.gov/diseases/hib
• https://www.cdc.gov/vaccines/vpd/pneumo/index.html
• https://www.idsociety.org/practice-guideline/bacterial-meningitis/
• Pharmacotherapy: A Pathophysiologic Approach, 10e Joseph T. Dipiro
• Articles from journals
• Clinical infectious disease
• Journal of Neurology
• British medical journal