Streptococcal Meningitis Not Recovering After Initial Antibiotic Treatment

This protocol addresses bacterial meningitis caused by Streptococcus pneumoniae in patients without a severe antibiotic (beta-lactam) allergy who have not achieved clinical recovery after completing the initial antibiotic course.

Previous treatment & failure condition

First-line management consisted of intravenous ceftriaxone — or cefotaxime when ceftriaxone was contraindicated. The goal of that treatment was clinical recovery within 10 days. Failure to reach that goal by day 10 is the trigger for escalation to the next step.

Next-step approach (partial overview)

When the patient has not recovered after the initial course, the evidence-based approach involves specialist input. The complete structured protocol sets out the recommended action in full.

Instant Access to Structured Evidence-Based Regimens

References

The committee agreed that ceftriaxone should be given as first-line treatment for Streptococcus pneumoniae meningitis, unless contraindicated in which case cefotaxime can be considered.
The committee agreed that a cephalosporin should still be considered if the nature of the allergic reaction they get is not severe, in accordance with the first line treatment recommended above.
The committee also agreed that advice from an infection specialist (a microbiologist or infectious diseases specialist) should be sought if people have not recovered after 10 days.

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