• Bacterial meningitis
In acute cases, the patient’s airways are checked as the first thing to do in order to assess any breathing or circulatory troubles. If any of those problems exist, they need to be managed by an emergency specialist before starting the antibiotic treatment. Intravenous fluids (applied directly into the veins) are preferred during the first 48 hours, and some patients may also need oxygen masks and anti-seizure medications.
2) Antibiotic treatment:
Bacterial meningitis is usually dangerous, and treatment should start after hospitalization as soon as possible. The patient is kept in a dim-lightened and quiet room to avoid seizures and photo-sensitivity. In most cases, doctors begin antibiotic therapy with broad-spectrum antibiotics once the suspicion is made and the patient is admitted into the hospital.
Still, a more specific antibiotic treatment is the best choice, and it will be determined by a procedure called lumbar puncture or spinal tap. Lumbar puncture should be done before starting antibiotic therapy. In a lumbar puncture, a physician asks the patient to lie on one side, introduces a needle into the spine and draws some of the spinal fluid to check for bacteria or other organisms. Once the causal bacteria are identified and got tested for antibiotic sensitivity, the doctor will choose the best antibiotic accordingly. A typical round of antibiotics takes from 5 days to 3 weeks according to the etiology (causal bacteria) and is applied into the veins for rapid effects (intravenously). Patients who are improving after six days of therapy can receive the rest of the treatment at home with the appropriate care, medical follow up, and under a specialist’s permission.
Steroids are applied into the veins (intravenously), along with or before starting the antibiotic therapy, and should be discontinued after four days in some instances. Steroids prevent brain swelling and help to reduce the risk of complications, especially hearing loss and neurological sequelae.
4) Fluids and pain killers:
Fluids are essential to prevent dehydration, while pain killers are given to provide analgesia (pain relief) and lower the fever. Both are given into the veins for rapid effects (intravenously).
5) Careful observation:
It’s essential during the whole course of the disease. A physician regularly checks for any signs of brain affection, seizures or complications. Continuous assessment and evaluation of the blood glucose levels and the mental status via especial scales are required.
6) Eliminating the source of infection:
In many cases, the source of infection is located in the paranasal sinus or middle ear (otitis media), so an otolaryngologist examines the patient to determine the source and treat its causes. Treatment may involve surgery for drainage of the infected areas. This promotes faster recovery from the current condition and reduces the risk of recurrence.
7) Measures for the close contacts:
If the bacterial meningitis is caused by a particular bacterial species called meningococcal bacteria, it will be important to give prophylactic antibiotic therapy to anyone who has been in contact with the patient recently in order to avoid their infection.
8) Complicated cases, e.g. meningococcal sepsis:
Patients receive more intensive antibiotic therapy and are stabilized regarding their blood flow and breathing.
• Viral meningitis
Despite being the most frequent type of meningitis, viral meningitis is usually self-limiting, which means the patient recovers spontaneously without specific treatment within a few days. Yet, patients should receive intravenous fluids and pain killers to minimize the pain and avoid dehydration.
Patients with specific immunity problems may need antibodies in a procedure called Immunoglobulin replacement.
Patients with suspected/confirmed viral encephalitis, on the other hand, are hospitalized and treated with antivirals, especially if Herpes (HSV- encephalitis) or influenza viruses are suspected/confirmed to be the cause. This reduces the risk of neurological complications, including permanent brain damage. Thus, viral meningitis must be differentiated from viral encephalitis to determine a suitable treatment plan.
Patients with (HSV-meningitis) should be referred to a sexual health clinic after recovery and treatment may include antivirals.
N.B. The physician might recommend antiviral therapy for some patients with HSV-meningitis.
• Fungal meningitis
Treatment depends on the immunity status of the patient. Intravenous and oral anti-fungal medications are recommended for all patients. However, the dosage and duration of treatment may change according to each patient with a much longer duration for immunocompromised patients and people living with HIV. Treatment regimen usually takes up to 10 weeks based on the regular testing results and clinical recovery.
During treatment, special measures are performed to keep the patient hydrated and stable. Thus, it is essential to check for blood electrolyte balance and to avoid drug toxicity.
There is not a prophylactic treatment for close contacts of the patient because fungal meningitis does not spread between humans.
• Tuberculous meningitis (TB meningitis)
It can be fatal, so hospitalization and treatment are necessary once TB meningitis is suspected.
The treatment primarily depends on specific antibiotic combinations called anti-tuberculous drugs. It takes 6 to 9 months for full recovery according to the patient’s response. The physician may also prescribe steroids in these cases.
• Parasitic meningitis (Eosinophilic meningitis)
Treatment depends on both steroids and pain killers. Doctors also perform measures to lower the intracranial pressure; such as repeated spinal tab (repeated withdrawal of little spinal fluid).
• Primary amebic meningoencephalitis (PAM)
Despite being almost always fatal, a particular combination of antibiotics, anti-fungal, anti-leishmanial agents and steroids is prescribed as a survival therapy for PAM patients.
• Non-infective meningitis
Since it arises due to various causes, it’s treated according to its actual cause.
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