Droplet Precautions for Bacterial Meningitis: What You Need to Know

Droplet Precautions for Bacterial Meningitis: What You Need to Know

Bacterial meningitis is a serious disease that can have long-lasting effects and potentially be fatal. This condition affects the meninges, the protective membranes surrounding the brain and spinal cord, and is caused by various bacteria.

Common Symptoms

Across all age groups, bacterial meningitis symptoms typically include fever, headache, neck stiffness, photophobia (sensitivity to light), altered mental status, and in infants, irritability, poor feeding, and bulging fontanelle (a soft spot on the skull).

Treatment

Prompt treatment is crucial in managing bacterial meningitis. Empiric antibiotics should be started as soon as the disease is suspected, ideally within an hour of presentation, even before cerebrospinal fluid (CSF) analysis.

• Adults younger than 50 years: Empiric antibiotics such as ceftriaxone (2 g IV every 12 hours) or cefotaxime (2 g IV every 6 hours) plus vancomycin (15-20 mg/kg IV every 8-12 hours) if penicillin-resistant Streptococcus pneumoniae is suspected.
• Adults 50 years or older: Add ampicillin (2 g IV every 4 hours) to cover Listeria monocytogenes.
• Neonates and children: Treatment regimens differ, but early antibiotic administration and tailored therapy after pathogen identification is essential.
• Adjunctive Therapy: Dexamethasone is recommended with antibiotics to reduce inflammation in some cases.
• Supportive care: Stabilizing the airway, managing intracranial pressure, and providing hemodynamic support as needed.

Prevention

Vaccination

The most effective prevention strategy involves routine immunizations against various bacteria that cause meningitis, such as Haemophilus influenzae type b (Hib), Streptococcus pneumoniae (pneumococcal conjugate vaccines, PCVs), and Neisseria meningitidis (meningococcal vaccines). Vaccination schedules cover infants, children, adolescents, and at-risk adults.

Hygiene and Transmission Prevention

Good hygiene practices, including washing hands often with soap and water or using hand sanitizer if soap and water are not available, can help reduce the risk of contracting bacterial meningitis. Additionally, avoiding sharing utensils or drinks can help prevent transmission.

Postexposure Prophylaxis

Close contacts of meningococcal disease cases should receive antibiotics to prevent secondary cases.

Summary by Age Group

• Neonates: Rapid diagnosis and treatment are critical, and empiric antibiotic regimens typically include ampicillin plus an aminoglycoside or cefotaxime. Vaccination focuses on maternal immunization and early infant immunization.
• Children: Routine pediatric vaccination with Hib, PCV, and meningococcal vaccines. Empiric antibiotics are based on age and the most common pathogens.
• Adults (<50 years): Focus on ceftriaxone or cefotaxime plus vancomycin. Vaccination for high-risk groups is recommended.
• Adults (≥50 years): Add ampicillin to cover Listeria.

Transmission and Spread Prevention

Bacterial meningitis spreads from person to person through droplets from the mouth and nose. Droplet precautions, such as isolation and wearing personal protective equipment (PPE), can help prevent the spread of meningitis. In the United States, approximately 375 total cases of meningitis occurred in 2019, with an incidence rate of 0.11 cases per 100,000 people.

Meningitis and Viruses

Some viruses can also cause meningitis, such as enteroviruses, measles, arboviruses, the mumps virus, herpes, and others. Most people with mild viral meningitis will recover without treatment within 7-10 days, but some may need care in a hospital. Antiviral medication may help meningitis if a herpes virus or influenza has caused the infection.

Precautions for Healthcare Professionals

The CDC recommends the following droplet precautions for healthcare professionals to prevent the spread of bacterial meningitis: wearing PPE, hand hygiene, handling contaminated items with caution, avoiding the reuse of face masks, and treating patients with meningitis in private rooms or with curtains for separation. Covering mouth and nose when coughing or sneezing, using the upper sleeve or elbow if tissue is not available, can help prevent the spread of meningitis. Individuals who come into contact with people with meningitis should wash their hands regularly and avoid reusing face masks or other disposable PPE.

[1] Centers for Disease Control and Prevention. (2021). Bacterial Meningitis. https://www.cdc.gov/meningitis/index.html [2] American Academy of Pediatrics. (2019). Diagnosis, Treatment, and Prevention of Bacterial Meningitis. https://pediatrics.aappublications.org/content/144/Supplement_1/S101 [3] World Health Organization. (2019). Meningitis. https://www.who.int/news-room/fact-sheets/detail/meningitis [4] National Institutes of Health. (2021). Meningitis. https://www.niams.nih.gov/health-topics/meningitis [5] Occupational Safety and Health Administration. (2021). Meningitis. https://www.osha.gov/SLTC/meningitis/index.html

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