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terial meningitis
Children over 2 years and adults (excep t fo r p regnant o r breast-feed ing wo m en)
oily chloramphenicol IM : 1 0 0 m g/ k g as a single d o se witho ut exceed ing 3 g. D ivid e the
d o se into two injectio ns if need ed , half-d o se in each butto ck . D o no t exceed ind icated
d o ses.
A ge 2 -5 y ears 6 -9 y ears 1 0 -1 4 y ears ≥1 5 y ears
D o se 1 .5 g 2 g 2 .5 g 3 g
or
ceftriaxone I M : 1 0 0 m g/ k g as a single d o se, m axim um 4 g. D ivid e the d o se into two
injectio ns if need ed , half-d o se in each butto ck .
A ge 2 -5 y ears 6 -9 y ears 1 0 -1 4 y ears ≥1 5 y ears
D o se 1 .5 g
2 .5 g 3g 4g
I f th ere is no clinical im p ro vem ent ( i.e. rep eated co nvulsio ns, fever > 3 8 .5 °C ,
ap p earance o r aggravatio n o f a red uced level o f co nscio usness o r o f neuro lo gical signs)
2 4 ho urs after the first injectio n: ad m inister a seco nd d o se o f the sam e antibio tic.
If there is no clinical im p ro vem ent (sam e signs as abo ve) 4 8 ho urs after beginning the
treatm ent ( i.e. after tw o co nsecutive d o ses o f o ily ch lo ram p h enico l o r ceftriaxo ne
ad m inistered at 2 4 -ho ur interval), review the d iagno sis. If no o ther d iagno sis has been
fo und (e.g. m alaria), co ntinue the treatm ent with ceftriaxo ne o nce d aily fo r 5 d ay s.
Children less than 2 years
T he treatm ent d ep end s o n the m o st p ro bable p atho gen and th e p atient‟s age, as fo r
m eningitis in no n-ep id em ic co ntext (see p age 1 6 9 ).
Pregnant or breast-feeding women 4g
ceftriaxone I M : 1 0 0 m g/ k g as a single d o se, m axim um
o r ampicilline IV at the d o ses ind icated p age 1 6 9
O ily chlo ram p henico l is co ntra-ind icated .
Additional treatment
– E nsure that 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 X X .
– C o m a: p reventio n o f bed so res, care o f the m o uth and ey es, etc.
– D exam ethaso ne in no t ind icated .
168
Children over 2 years and adults (excep t fo r p regnant o r breast-feed ing wo m en)
oily chloramphenicol IM : 1 0 0 m g/ k g as a single d o se witho ut exceed ing 3 g. D ivid e the
d o se into two injectio ns if need ed , half-d o se in each butto ck . D o no t exceed ind icated
d o ses.
A ge 2 -5 y ears 6 -9 y ears 1 0 -1 4 y ears ≥1 5 y ears
D o se 1 .5 g 2 g 2 .5 g 3 g
or
ceftriaxone I M : 1 0 0 m g/ k g as a single d o se, m axim um 4 g. D ivid e the d o se into two
injectio ns if need ed , half-d o se in each butto ck .
A ge 2 -5 y ears 6 -9 y ears 1 0 -1 4 y ears ≥1 5 y ears
D o se 1 .5 g
2 .5 g 3g 4g
I f th ere is no clinical im p ro vem ent ( i.e. rep eated co nvulsio ns, fever > 3 8 .5 °C ,
ap p earance o r aggravatio n o f a red uced level o f co nscio usness o r o f neuro lo gical signs)
2 4 ho urs after the first injectio n: ad m inister a seco nd d o se o f the sam e antibio tic.
If there is no clinical im p ro vem ent (sam e signs as abo ve) 4 8 ho urs after beginning the
treatm ent ( i.e. after tw o co nsecutive d o ses o f o ily ch lo ram p h enico l o r ceftriaxo ne
ad m inistered at 2 4 -ho ur interval), review the d iagno sis. If no o ther d iagno sis has been
fo und (e.g. m alaria), co ntinue the treatm ent with ceftriaxo ne o nce d aily fo r 5 d ay s.
Children less than 2 years
T he treatm ent d ep end s o n the m o st p ro bable p atho gen and th e p atient‟s age, as fo r
m eningitis in no n-ep id em ic co ntext (see p age 1 6 9 ).
Pregnant or breast-feeding women 4g
ceftriaxone I M : 1 0 0 m g/ k g as a single d o se, m axim um
o r ampicilline IV at the d o ses ind icated p age 1 6 9
O ily chlo ram p henico l is co ntra-ind icated .
Additional treatment
– E nsure that 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 X X .
– C o m a: p reventio n o f bed so res, care o f the m o uth and ey es, etc.
– D exam ethaso ne in no t ind icated .
168
