Uganda guidelines for the treatment of Bacterial Meningitis

Avoid overcrowding. Improve sanitation and nutrition.

Prompt treatment of primary infections (e.g., respiratory tract).

Immunisation as per national schedules (PCV, Hib, meningococcal).

Mass immunisation if Neisseria meningitidis epidemic.

General Measures

Refer all patients to hospital after pre-referral dose of antibiotic. Perform lumbar puncture promptly and initiate empirical antibiotic regimen. IV fluids, temperature control, and nutritional support.

Empirical Treatment — Unknown Organism

Ceftriaxone 2 g IV or IM every 12 hours. Child: 100 mg/kg daily dose. If ceftriaxone unavailable or no improvement: Chloramphenicol 1 g IV every 6 hours for up to 14 days (IM if IV unavailable). Child: 25 mg/kg per dose.

Streptococcus pneumoniae (10–14 days, up to 21 in severe cases)

Benzylpenicillin 3–4 MU IV or IM every 4 hours. Child: 100,000 IU/kg per dose. OR Ceftriaxone 2 g IV or IM every 12 hours. Child: 100 mg/kg daily.

Haemophilus influenzae (10-day course)

Ceftriaxone 2 g IV or IM every 12 hours. Child: 100 mg/kg per dose. If susceptible: may switch to appropriate alternative after C&S results.

Neisseria meningitidis (up to 14-day course)

Benzylpenicillin 5–6 MU IV every 6 hours. Child: 100,000–150,000 IU/kg every 6 hours. OR Ceftriaxone 2 g IV or IM every 12 hours. OR Chloramphenicol 1 g IV every 6 hours (IM if needed). Close contact prophylaxis: Ciprofloxacin 500 mg single dose (adult); 10 mg/kg (child <12 yrs). In pregnancy: Ceftriaxone 250 mg IM single dose.

Listeria monocytogenes (≥3 weeks — neonates and immunosuppressed)

Benzylpenicillin 3–4 MU IV every 4 hours. Plus Gentamicin 1–1.7 mg/kg every 8 hours.

Supportive Care

Prevent hypoglycaemia (breastfeed if possible; NGT or IV glucose). Ensure hydration and nutrition. Oxygen if SpO2 <92%.

Empirical Regimen (21 days)

Ampicillin IV: neonate <7 days: 50–100 mg/kg every 12 hours; neonate ≥7 days: 50–100 mg/kg every 8 hours. PLUS Gentamicin 2.5 mg/kg IV every 12 hours.

Group B Streptococcal Meningitis

Benzylpenicillin: neonate ≥7 days: 100,000–150,000 IU/kg IV every 4–6 hours; neonate <7 days: 50,000–100,000 IU/kg IV every 8 hours. PLUS Gentamicin 2.5 mg/kg IV every 12 hours. Continue for 3 weeks total.