Meningitis management (176/1700)

A 23yo lady presents with headache. Exam: photophobia and generalized rash that doesn’t
blanch on pressure. What must be done immediately?

a. IV benzylpenicillin
b. Isolate pt
c. Gown and mask
d. Blood culture





























answer A

from nice

if there is any clinical suspicion of bacterial meningitis with non-blanching rash or meningococcal septicaemia
  • Admit the person as an emergency by telephoning 999.
  • Administer a single dose of parenteral benzylpenicillin at the earliest opportunity, provided that treatment does not delay urgent transfer to hospital.
    • Ideally, benzylpenicillin should be given intravenously, or intramuscularly if a vein is not available.
    • If given intramuscularly, it should be given as proximally as possible — preferably into a part of the limb that is still warm (as cold areas will be less well perfused).
    • Dosage:
      • Adults and children 10 years of age or older — 1200 mg.
      • Children 1–9 years of age — 600 mg.
      • Children younger than 1 year of age — 300 mg.
    • Benzylpenicillin should be carried in GP emergency bags, and checked regularly to ensure that it is within its expiry date.
  • Withhold benzylpenicillin if the person has a clear history of penicillin anaphylaxis (a history of a rash following penicillin is not a contraindication).

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