Optimal management of meningitis or brain abscess

Optimal management of bacterial meningitis:

• Start empirical intravenous ceftriaxone at the highest BNF-recommended dose immediately when bacterial meningitis is suspected, unless contraindicated, in which case cefotaxime is an alternative (especially in pre-term babies under 41 weeks corrected gestational age) ¹.
• For patients with risk factors for Listeria monocytogenes, add intravenous amoxicillin or ampicillin to ceftriaxone or cefotaxime ¹.
• Do not routinely give intravenous aciclovir unless herpes simplex encephalitis is strongly suspected ¹.
• Continue initial antibiotic treatment until microbiological results guide therapy or an alternative diagnosis is made; if CSF suggests bacterial meningitis but blood cultures and PCR are negative, continue antibiotics for 10 days and reassess ¹.
• Specific antibiotic durations vary by causative organism: 5 days for Neisseria meningitidis, 7-10 days for Haemophilus influenzae type b, 10 days for Streptococcus pneumoniae, 14 days for group B streptococcus, 21 days for Enterobacterales and Listeria monocytogenes (with co-trimoxazole added for the first 7 days in Listeria) ¹.
• In cases of antibiotic allergy, seek infection specialist advice; mild allergies may still allow ceftriaxone or cefotaxime use, while severe allergies may require co-trimoxazole and chloramphenicol ¹.
• Monitor for raised intracranial pressure or hydrocephalus and seek specialist advice for intracranial pressure monitoring ¹.
• Assess for immunodeficiency and recurrence risk, including HIV testing in adults and selected children, and refer to specialists as appropriate ¹.

Optimal management of brain abscesses:

• The provided guideline excerpts do not specifically address brain abscess management; however, standard UK practice involves prompt neurosurgical consultation for drainage when indicated, combined with prolonged intravenous antibiotic therapy tailored to microbiological findings.
• Empirical antibiotic regimens often include agents effective against common causative organisms such as streptococci, anaerobes, and staphylococci, adjusted based on culture results.
• Management also includes monitoring and controlling intracranial pressure and supportive care.