Meningitis, Recurrent

- Recurrent meningitis requires evaluation of underlying cause:

  • congenital anatomical defect (epidermoid/dermoid cysts, neural tube defects, asplenia)
  • acquired anatomical defect (head injuries, basal skull fracture, malignancy)
  • congenital immunodeficiencies (complement deficiency, agammaglobulinemia, IgG subclass deficiency, IRAK 4 deficiency)
  • acquired immunodeficiencies - HIV
  • chronic parameningeal infections (sinusitis, otitis media, mastoiditis)

NB:

- Anatomical defects most commonly cause recurrent S. pneumoniae or H. influenzae meningitis.

- Complement deficiency is associated with recurrent N. meningitidis meningitis. Vaccination for S. pneumoniae, N. meningitidis, H. influenzae recommended for asplenia or complement deficiency.

 
Usual Pathogens
Bacterial:

S. pneumoniae
N. meningitidis
H. influenzae
S. aureus
Enterobacterales

 

Empiric Therapy Dose Duration
Vancomycin 60mg/kg/d IV div q6h S. pneumoniae, N. meningitidis, H. influenzae - 10 days 
S. aureus -14 days after last positive blood culture
Enterobacterales - 21 days
+    
Ceftriaxone 100mg/kg/d IV div q12h