Question

A 25-year-old lady is admitted in the ward with recent onset high grade fever. She is being evaluated for suspected meningitis.
How will you manage meningitis?

Hint:

For suspected bacterial meningitis, do not delay empirical antibiotic therapy while awaiting culture results. Early treatment improves prognosis.

Answer 1

Step 1: Empirical Antibiotic Therapy.
If bacterial meningitis is suspected, prompt initiation of empirical broad-spectrum antibiotics is crucial. Common regimens include Ceftriaxone or Cefotaxime combined with Vancomycin. In cases where Listeria is suspected, Ampicillin is added. For suspected meningococcal meningitis, Rifampin may be administered as prophylaxis for close contacts.

Step 2: Supportive Care.
Supportive care includes hydration, pain management (e.g., acetaminophen), and antiemetics for nausea and vomiting. Monitoring vital signs and neurological status is critical for early detection of complications.

Step 3: Specific Treatment.
Once the causative agent is identified via cerebrospinal fluid (CSF) culture or PCR, antibiotics are adjusted accordingly. For viral meningitis, treatment is supportive, as most cases are self-limiting. Antiviral medications may be given for herpes simplex virus (HSV) meningitis. For fungal meningitis, antifungal therapy is initiated.

Step 4: Monitoring and Follow-up.
Patients with meningitis require close monitoring in a hospital setting, especially in the first 24-48 hours. Follow-up imaging (CT or MRI) may be needed if there are complications, such as raised intracranial pressure.

Step 5: Conclusion.
Management of meningitis requires prompt initiation of antibiotics, supportive care, and specific treatment based on the causative organism. Close monitoring and follow-up are essential for improving patient outcomes.