Bacterial Meningitis — Uganda (General Adult population)
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.
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