When patients present to a first-contact setting (e.g. - general practice, out of hours or walk-in centres, emergency departments etc), health professionals should:
- identify any immediately life-threatening features
- assess the likelihood of serious illness or self-limiting illness, without necessarily diagnosing a particular condition
- determine a source of the illness to direct specific treatment
- make appropriate management decisions based on the results of assessment (1).
If a patient suspected bacterial meningitis or meningococcal disease is identified in the pre-hospital setting, they should be transferred to secondary care urgently.
- if meningococcal meningitis or haemophilus influenzae meningitis is suspected then a single STAT dose of benzylpenicillin should be administered by the general practitioner before transfer to hospital
- the benefit to the patient of early treatment outweighs the chance of isolating the organism
Transfer all patients to hospital immediately
If time before hospital admission, and if suspected meningococcal septicaemia or non-blanching rash, give IV benzylpenicillin as soon as possible (2)
- withhold benzylpenicillin only in children and young people who have a clear history of anaphylaxis after a previous dose of penicillin; a history of a rash following penicillin is not a contraindication (1)
Recommended doses are (2):
- in adults and children of 10 years or more : IV or IM benzylpenicillin 1.2 g
- for children 1 to 9 years : IV or IM benzylpenicillin 600 mg
- for children less than 1 year : IV or IM benzylpenicillin 300 mg
The dose should be given as soon as possible - ideally administration should be intravenous. Intramuscular administration is less likely to effective in shocked patients as a result of reduced tissue perfusion. However intramuscular administration should be used if a venous access cannot be found.
Note that benzylpenicillin should be witheld if there is a known history of anaphylaxis following penicillin administration. Cefotaxime is an alternative in this case.
- STAT indicates that intervension is emergent
- a critical review of early management of meningitis has suggested that supportive care such as oxygen and intravenous fluids is as important as early antibacterial therapy (3)
- NICE suggest regarding pre-hospital management of suspected bacterial meningitis and meningococcal septicaemia (1)
- primary care healthcare professionals should transfer children and young people with suspected bacterial meningitis or suspected meningococcal septicaemia to secondary care as an emergency by telephoning 999
- suspected bacterial meningitis without non-blanching rash
- transfer children and young people with suspected bacterial meningitis without non-blanching rash directly to secondary care without giving parenteral antibiotics
- if urgent transfer to hospital is not possible (for example, in remote locations or adverse weather conditions), administer antibiotics to children and young people with suspected bacterial meningitis
- suspected meningococcal disease (meningitis with non-blanching rash or meningococcal septicaemia)
- give parenteral antibiotics (intramuscular or intravenous benzylpenicillin) at the earliest opportunity, either in primary or secondary care, but do not delay urgent transfer to hospital to give the parenteral antibiotics
- withhold benzylpenicillin only in children and young people who have a clear history of anaphylaxis after a previous dose; a history of a rash following penicillin is not a contraindication