<b>General measures</b><br>ffIV fluids ffControl of temperature ffNutrition support (NGT if necessary)}<b>Causative organisms not yet identified</b><br>ffStart initial appropriate empirical broad spectrum therapy –– Ceftriaxone 2 g IV or IM every 12 hours for 10-14 days Child: 100 mg/kg daily dose given as above –– Change to cheaper effective antibiotic if and when C&S results become available}<b>If ceftriaxone not available/not improving</b><br>ffUse chloramphenicol 1 g IV every 6 hours for up to 14 days (use IM if IV not possible) Child: 25 mg/kg per dose<br><b>Once clinical improvement occurs</b>–– Change to 500-750 mg orally every 6 hours to complete the course; Child: 25 mg/kg per dose}<b>Causative organisms identified Streptococcus pneumoniae (10-14 day course; up to 21 days in severe case)</b><br>ffBenzylpenicillin 3-4 MU IV or IM every 4 hours Child: 100,000 IU/kg per dose ffOr ceftriaxone 2 g IV or IM every 12 hours Child: 100 mg/kg daily dose}<b>Haemophilus influenzae (10 day course)</b><br>ffCeftriaxone 2 g IV or IM every 12 hours Child: 100 mg/kg per dose Only if the isolate is reported to be susceptible to the particular drug ffChange to chloramphenicol 1 g IV every 6 hours Child: 25 mg/kg per dose ffOr ampicillin 2-3 g IV every 4-6 hours Child: 50 mg/kg per dose}<b>Neisseria meningitidis (up to 14 day course)</b><br>ffBenzylpenicillin IV 5-6 MU every 6 hours Child: 100,000-150,000 IU/kg every 6 hours ffOr Ceftriaxone 2 g IV or IM every 12 hours Child: 100 mg/kg daily dose ffOr Chloramphenicol 1 g IV every 6 hours (IM if IV not possible) Child: 25 mg/kg IV per dose<br><b>Once clinical improvement occurs</b><br>–– Change to chloramphenical 500-750 mg orally every 6 hours to complete the course Child: 25 mg/kg per dose Note: Consider prophylaxis of close contacts (especially children < 5 years): ffAdults and children >12 years: Ciprofloxacin 500 mg single dose Child <12 yrs: 10 mg/kg single dose ffAlternative (e.g. in pregnancy): ceftriaxone 250 mg IM single dose Child < 12 yrs: 150 mg IM single dose}<b>Listeria monocytogenes (at least 3 weeks course)</b><br>Common cause of meningitis in neonates and immunosuppressed adults ffBenzylpenicillin 3 MU IV or IM every 4 hours ffOr ampicillin 3 g IV every 6 hours Notes ww Both medicines are equally effective ww Therapy may need to be prolonged for up to 6 weeks in some patients