Case of the Month #5 - Pneumococcal Meningitis

Published 03/02/2022



  • Cephalosporin (Ceftriaxone often first line due to CNS penetration)
  • Consider deescalation as cultures become available
  • Prolonged (>10 days) course often required


  • Usually Aciclovir initially 10mg/kg IV TDS
  • Up to 14-21 days in HSV encephalitis
  • Other viral causes may require alternative antivirals


  • Dexamethasone 10mg IV QDS
  • Mortality reduction in Pneumococcal Meningitis only
  • Reduction in incidence of hearing loss and other neurological sequalae in all bacterial meningitis.


  • Immunosuppression mainstay
  • Early specialist involvement

Supportive Care:

  • Optimise Cerebral Perfusion
  • DVT Prophylaxis

Specific Complications:

  • Refractory Status Epilepticus/NCSE
  • Raised ICP – Routine ICP monitoring is not recommended
  • Cerebrovascular Accident
  • Venous Sinus Thrombosis
  • Hearing/Visual Defects