Meningitis: community-acquired meningitis - Pathogen Specific

Causative pathogen

Duration and / or choice

Additional info

If causative organism cannot be identified

i.e cerebrospinal fluid results suggest bacterial meningitis, but the blood culture and whole-blood diagnostic polymerase chain reaction are negative

• Continue antibiotic for 10 days 
• Stop antibiotic after 10 days if the patient has recovered 

Discuss with Micro/ID about whether or not to continue dexamethasone.

 Streptococcus pneumoniae

• Stop antibiotic after 10 days if the patient has recovered 
• benzylpenicillin 2.4g iv 4-hourly IF
  • Cultures show penicillin susceptible

AND

• • MIC is 0.06 microgram/mL or less

Continue dexamethasone for up to 4 days

 Haemophilus influenzae type b

• Stop antibiotic after 7 days if the patient has recovered

      OR

• Continue antibiotic for a total of 10 days if patient has not recovered 

Continue dexamethasone for up to 4 days

Group B streptococcal meningitis

• Stop antibiotic after 14 days if the patient has recovered
• benzylpenicillin 2.4g iv 4-hourly if cultures show penicillin susceptible

Enterobacterales (coliforms)

• Stop antibiotic after 21 days if the patient has recovered

Micro/ID may advise using meropenem as an alternative to ceftriaxone, while awaiting antibiotic sensitivities

Listeria monocytogenes

• Stop antibiotic after 21 days if the patient has recovered

Micro/ID may advise intravenous co-trimoxazole in addition to amoxicillin for the first 7 days 

Neisseria meningitidis

• Stop antibiotic after 5 days if the patient has recovered 
• benzylpenicillin 2.4g iv 4-hourly IF
  • Cultures show penicillin susceptible

AND

• • MIC is less than 0.1 microgram/mL