Who should you give antibiotics to if you suspect meningitis?
- If they have a non-blanching rash
- If you suspect meningococcal septicaemia
- If transfer to hospital could be delayed (eg in rural areas).
NB – you should not give antibiotics if you suspect meningitis, but there is just a blanching rash, as long as transfer to hospital will not be delayed.
Use im benzylpenicillin.
Who needs prophylactic antibiotics after exposure?
- House-hold close contacts in the last 7d (eg family / shared house / university accommodation with a shared living space).
- Partners – only if there has been mouth to mouth kissing in the last 7d.
- Healthcare workers – but only when there has been a clear perception of respiratory secretions onto the persons face (eg suction / intubating).
- Others (including healthcare workers ) can be reassured that transmission is unusual. For close contacts as above it is 1 in 300, in pre-school 1 in 1500 and in primary school 1 in 18000.
- Prophylaxis isn’t really aimed at stopping transmission from the case, but from a shared asymptomatic source. It is only useful in the first 30d, and ideally should be offered within 24hrs.
- Ciprofloxacin is the preferred prophylaxis in all age groups and in pregnancy.
Who needs vaccination?
Anyone who would fit the criteria for prophylactic antibiotics.
See the Green Book / Guideline for advice on what to give and in what course.