C. Oral rifampicin – Explanation
The BNF recommends a twice a day dose of rifampicin for two days, based on the patients weight.
Meningitis: management
Investigations suggested by NICE
- full blood count
- CRP
- coagulation screen
- blood culture
- whole-blood PCR
- blood glucose
- blood gas
Lumbar puncture if no signs of raised intracranial pressure
Management
All patients should be transferred to hospital urgently. If patients are in a pre-hospital setting (for
example a GP
surgery) and meningococcal disease is suspected then intramuscular benzylpenicillin may be given,
as long as this doesn’t delay transit to hospital.
BNF recommendations on antibiotics
| Initial empirical therapy aged 3 months – 50 years | Intravenous cefotaxime |
| Initial empirical therapy aged > 50 years | Intravenous cefotaxime + amoxicillin |
| Meningococcal meningitis | Intravenous benzylpenicillin or cefotaxime |
| Pneuomococcal meningitis | Intravenous cefotaxime |
| Meningitis caused by Haemophilus influenzae | Intravenous cefotaxime |
| Meningitis caused by Listeria | Intravenous amoxicillin + gentamicin |
If the patient has a history of immediate hypersensitivity reaction to penicillin or to cephalosporins
the BNF recommends using chloramphenicol.
Management of contacts
- prophylaxis needs to be offered to household and close contacts of patients affected with
meningococcal meningitis - oral rifampicin or ciprofloxacin may be used
- the risk is highest in the first 7 days but persists for at least 4 weeks
- meningococcal vaccination should be offered when serotype results are available, for close
contacts who have not previously been vaccinated
