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7. Bacterial diseases
Treatment in a non-epidemic context
Antibiotic therapy
F o r the cho ice o f antibio tic therap y and d o sages acco rd ing to age, see fo llo wing p age
169.
D uratio n o f antibio tic therap y :
1 ) A cco rd ing to the p atho gen:
• Haemophilus influenzae: 7 d ay s
• Streptococcus pneumoniae: 1 0 -1 4 d ay s
• Group B streptococcus and Listeria: 1 4 -2 1 d ay s
• Gram-negative bacilli: 2 1 d ay s
• Neisseria meningitidis: see Antibiotic therapy in an epidemic context
2 ) If the p atho gen is unk no wn:
C hild ren < 3 m o nths: 2 week s bey o nd the first sterile C S F culture o r 2 1 d ay s
C hild ren > 3 m o nths and ad ults: 1 0 d ay s. C o nsid er extend ing treatm ent o r
alternative
d iagno ses if fever p ersists bey o nd 1 0 d ay s. O n th e o ther h and , a 7 -d ay co urse o f
ceftriaxo ne is sufficient in p atients who are m ak ing an unco m p licated reco very .
Additional treatment
– D exam eth aso ne red uces th e risk o f h earing lo ss in p atients with H. influenzae o r
S. pneumoniae. E arly ad m inistratio n in ind icated in m eningitis caused by th ese
7dpexaathmoetghaesnosnoe IrVwh: en the p atho gen is unk no wn, excep t in neo nates (and in p resum ed
m eningo co ccal m eningitis in an ep id em ic co ntext).
C hild ren > 1 m o nth and ad ults: 0 .1 5 m g/ k g (m ax. 1 0 m g) every 6 ho urs fo r 2
d ay s.
T he treatm ent sho uld be started befo re o r with the first d o se o f antibio tic, o therwise,
the treatm ent o ffers no benefit.
– E nsure th at the p atient is well fed and well hy d rated (infusio ns o r naso gastric tube if
necessary ).
– S eiz ures: see p age 2 3 .
– C o m a: p reventio n o f bed so res, care o f the m o uth and ey es, etc.
Treatment in an epidemic context
2
Antibiotic therapy
I n this co ntext, N. meningitidis is the m o st lik ely p atho gen. F irst- line treatm ent ( in o ut-
p atients) is eith er o ily ch lo ram p h enico l o r ceftriaxo ne ad m inistered as a single I M
d o se.
Refer to the MSF handbook Management of epidemic meningococcal meningitis.
1
Treatment in a non-epidemic context
Antibiotic therapy
F o r the cho ice o f antibio tic therap y and d o sages acco rd ing to age, see fo llo wing p age
169.
D uratio n o f antibio tic therap y :
1 ) A cco rd ing to the p atho gen:
• Haemophilus influenzae: 7 d ay s
• Streptococcus pneumoniae: 1 0 -1 4 d ay s
• Group B streptococcus and Listeria: 1 4 -2 1 d ay s
• Gram-negative bacilli: 2 1 d ay s
• Neisseria meningitidis: see Antibiotic therapy in an epidemic context
2 ) If the p atho gen is unk no wn:
C hild ren < 3 m o nths: 2 week s bey o nd the first sterile C S F culture o r 2 1 d ay s
C hild ren > 3 m o nths and ad ults: 1 0 d ay s. C o nsid er extend ing treatm ent o r
alternative
d iagno ses if fever p ersists bey o nd 1 0 d ay s. O n th e o ther h and , a 7 -d ay co urse o f
ceftriaxo ne is sufficient in p atients who are m ak ing an unco m p licated reco very .
Additional treatment
– D exam eth aso ne red uces th e risk o f h earing lo ss in p atients with H. influenzae o r
S. pneumoniae. E arly ad m inistratio n in ind icated in m eningitis caused by th ese
7dpexaathmoetghaesnosnoe IrVwh: en the p atho gen is unk no wn, excep t in neo nates (and in p resum ed
m eningo co ccal m eningitis in an ep id em ic co ntext).
C hild ren > 1 m o nth and ad ults: 0 .1 5 m g/ k g (m ax. 1 0 m g) every 6 ho urs fo r 2
d ay s.
T he treatm ent sho uld be started befo re o r with the first d o se o f antibio tic, o therwise,
the treatm ent o ffers no benefit.
– E nsure th at the p atient is well fed and well hy d rated (infusio ns o r naso gastric tube if
necessary ).
– S eiz ures: see p age 2 3 .
– C o m a: p reventio n o f bed so res, care o f the m o uth and ey es, etc.
Treatment in an epidemic context
2
Antibiotic therapy
I n this co ntext, N. meningitidis is the m o st lik ely p atho gen. F irst- line treatm ent ( in o ut-
p atients) is eith er o ily ch lo ram p h enico l o r ceftriaxo ne ad m inistered as a single I M
d o se.
Refer to the MSF handbook Management of epidemic meningococcal meningitis.
1
