Empirical therapy

Initial empirical therapy includes(1):

• urgent transfer to hospital
• in general practice, if bacterial meningitis is suspected a single STAT dose of benzylpenicillin should be given before urgent transfer to the hospital
• dexamethasone may be indicated as an adjunct in adults, before or when antibiotics are started.

Alternative therapies that may be used as empirical therapy based on the likely agent for the age of the patient are:

• infants younger than three months:
  • cefotaxime, and ampicillin because of the possibility of Listeria meningitis
• children:
  • ceftriaxone or cefotaxime
  • second line is chloramphenicol and ampicillin
• adults:
  • ceftriaxone or cefotaxime
  • second line therapies: benzylpenicillin or ampicillin
• older adults:
  • cefotaxime or ceftriaxone and ampicillin

Note: STAT indicates that intervention is emergent

Reference:

• (1) Meningitis Research Foundation 2018. Meningococcal Meningitis and Sepsis. Guidance notes. Diagnosis and treatment in general practice