Meningitis – HPA advice

This publication from the HPA mostly summaries advice from the NICE guideline. Given it’s importance to us though, here’s a quick summary:

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.

Louise Hudman

I'm a freelance GP locum in Winchester & Southampton.

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