Purulent meningitis management

• Comparative analysis of clinical characteristics of term and preterm neonates with necrotizing enterocolitis undergoing surgery
• Clinical characteristics and post-operative outcomes in children with purulent meningitis with hydrocephalus: 46 cases in a single center study
• Computed Tomographic and Magnetic Resonance Imaging Diagnosis of Concurrent Sinonasal Aspergillosis and Meningoencephalocele in a Dog
• The role of isoniazid dosage and NAT2 gene polymorphism in the treatment of tuberculous meningitis
• Positive real-time PCR in pneumococcal meningitis 12 hours after initiation of antibiotic therapy - case report
• Case report: Trauma-induced Klebsiella pneumoniae invasive syndrome presenting with liver abscess, lung abscess, endophthalmitis, and purulent meningitis
• Predicting purulent meningitis in very preterm infants: a novel clinical model
• Subarachnoid anesthesia for sacrococcygeal pilonidal disease treatment: A case report

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