Purulent meningitis management [Neurosurgery Wiki]

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====== Purulent meningitis management ======

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**1. Initial Measures**
  * Ensure ABCs (Airway, Breathing, Circulation)
  * Start empirical IV antibiotics immediately after blood cultures:
    * Ceftriaxone or cefotaxime + vancomycin
    * Add ampicillin if *Listeria* is suspected (elderly, neonates, immunocompromised)
  * Administer dexamethasone (10 mg IV q6h) ideally before or with first antibiotic dose

**2. Diagnostic Workup**
  * Blood cultures x2
  * Lumbar puncture (LP), unless contraindicated:
    * CSF: cell count, glucose, protein, Gram stain, culture, PCR
  * CT/MRI before LP if:
    * Altered mental status
    * Focal neurologic signs
    * Signs of raised intracranial pressure

**3. Supportive Care**
  * ICU monitoring for severe cases
  * IV fluids and antipyretics
  * Anticonvulsants if seizures
  * ICP management (mannitol, hypertonic saline, EVD)

**4. Targeted Antibiotic Therapy**
  * Adjust based on culture and sensitivity
  * Duration:
    * *N. meningitidis*: 5–7 days
    * *H. influenzae*: 7–10 days
    * *S. pneumoniae*: 10–14 days
    * *Listeria*, *Gram-negatives*: ≥21 days

**5. Management of Complications**
  * **Hydrocephalus** → consider EVD or ventriculoperitoneal shunt
  * **Sensorineural hearing loss** → audiology referral
  * **Neurological deficits** → rehabilitation, follow-up

**Related topics:**
  * Bacterial meningitis
  * External ventricular drainage
  * CSF analysis