{ "schema_version": 1, "kind": "condition", "id": "meningitis-suspected", "name": "Suspected Meningitis (Emergency Referral)", "category": "infectious", "sources": "Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, Meningitis and Other CNS Infections: IV 2 g every 12 hours) · Egyptian National Drug Formulary - Antimicrobial 2023 (chloramphenicol monograph, Serious infections including bacterial meningitis) · NICE Guideline NG240: Meningitis (bacterial) and meningococcal disease 2024", "review_status": "reviewed", "verified_against": "Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, Meningitis and Other CNS Infections: IV 2 g every 12 hours) · Egyptian National Drug Formulary - Antimicrobial 2023 (chloramphenicol monograph, Serious infections including bacterial meningitis)", "verified_date": "2026-08", "treatments": [ { "id": 1140, "generic": "Ceftriaxone", "line": 1, "is_adjunct": false, "form": "injection", "strength_mg": 1000.0, "adult_dose": "2 g IV. The formulary's meningitis regimen is 2 g every 12 hours; what is given before transfer is the first dose of it. Do not delay the transfer to give it", "adult_duration": "First dose before transfer; the course is continued in hospital", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (ceftriaxone monograph, Meningitis and Other CNS Infections: IV 2 g every 12 hours)", "rationale": "Third-generation cephalosporin with good central nervous system penetration, covering the meningococcal and pneumococcal pathogens of bacterial meningitis; given pre-hospital only when it will not delay the transfer that is the real priority.", "cautions": [ "The transfer comes first. NG240 says give ceftriaxone or benzylpenicillin as soon as possible outside hospital UNLESS that delays getting the patient there. For strongly suspected bacterial meningitis, as opposed to meningococcal disease with a rash, give it outside hospital only if the delay in transfer is going to be clinically significant.", "LIFE-THREATENING EMERGENCY: Transfer immediately to hospital emergency department via emergency ambulance.", "Give pre-hospital antibiotic (ceftriaxone) immediately if meningococcal disease (non-blanching rash) or bacterial meningitis is suspected, unless it delays transfer.", "Do not delay hospital transfer to perform lumbar puncture or diagnostic investigations in primary care.", "NG240 names benzylpenicillin alongside ceftriaxone and it is often the one actually to hand outside a hospital. If benzylpenicillin is what is in the bag, it is a legitimate choice under the same recommendation.", "The 2 g is the formulary's meningitis dose, which it gives as 2 g every 12 hours by the intravenous route. The single-dose, intramuscular pre-hospital framing is practice, not something any document consulted here states - NG240 itself names no doses at all and refers to the BNF, which is not reachable from Egypt." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "The formulary gives no single pre-hospital dose for a child. Its meningitis regimen is 100 mg/kg/day divided every 12 to 24 hours, maximum 4,000 mg/day; for premature and term neonates, 50 mg/kg/dose IV or IM every 24 hours. A single dose before a long transfer is a prescriber's decision, not a figure that can be cited here. Below 1 month, cefotaxime is preferred over ceftriaxone to avoid displacing bilirubin.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "ZOXIDEL 1 GM PD. FOR I.M. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 22.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "CEFTRIAXONE SODIUM 1 GM I.M.VIAL (KAHIRA)", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "KAHIRA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "ZOXIDEL 1 GM PD. FOR I.V. INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > DELTA PHARMA", "price_egp": 29.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "WINTRIAXONE 1 GM PD. FOR I.V INJ.", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "SANOFI", "price_egp": 48.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "VOTRIAXONE 1 GM I.M VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CHEMIPHARM", "price_egp": 56.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "OFRAMAX 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "RAMEDA > SUN PHARMA EGYPT LIMITED", "price_egp": 71.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.M. VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null }, { "trade_name": "TRIAXONE 1 GM I.V VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "TABUK PHARMACEUTICAL MANUFACTURING COMPANY > TABUK PHARMA", "price_egp": 106.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "meningitis-suspected" }, { "id": 1141, "generic": "Chloramphenicol", "line": 2, "is_adjunct": false, "form": "injection", "strength_mg": 1000.0, "adult_dose": "IV: 50 to 100 mg/kg/day in divided doses every 6 hours, maximum 4 g daily, with plasma concentration monitoring. The formulary gives no single pre-hospital dose", "adult_duration": "A hospital regimen; there is no sourced single dose to give before transfer", "dose_source": "Egyptian National Drug Formulary - Antimicrobial 2023 (chloramphenicol monograph, Serious infections including bacterial meningitis)", "rationale": "Chloramphenicol IV is the established pre-hospital alternative for patients with a clear history of anaphylaxis to penicillins or cephalosporins.", "cautions": [ "The formulary's 25 mg/kg is a neonatal DAILY total split over four doses, not a single dose, and it gives no 1.2 g single adult dose. Chloramphenicol causes fatal aplastic anaemia and grey syndrome - read the figures against the monograph before prescribing.", "Intravenous only. The Egyptian formulary states chloramphenicol given intramuscularly does not reach effective concentrations - in the one situation it is listed for, it would be no treatment at all. With no IV access, transfer without it.", "NG240 is against giving anything outside hospital in this situation: do not give antibiotics outside of hospital if the person has severe allergy to ceftriaxone or benzylpenicillin. Chloramphenicol appears in that guideline only as an in-hospital option on infection-specialist advice. It is listed here because a long transfer from outside Cairo is a different problem from a London ambulance ride - but it is a departure from NG240 and should be a considered one.", "Reserved for patients with severe anaphylactic allergy to beta-lactam antibiotics.", "Emergency hospital transfer remains mandatory.", "The formulary's chloramphenicol dosing is a monitored hospital regimen - divided doses every 6 hours with plasma levels. It is not written for a single dose given before a transfer, and no source reachable gives one. If you give a dose before transferring a doubly-allergic patient, that is your decision and it is outside anything that can be cited here." ], "peds_mgkg_low": null, "peds_mgkg_high": null, "peds_max_mg": null, "peds_basis": null, "peds_unit": null, "peds_note": "Neonates: 25 mg/kg DAILY, given in 4 equally divided doses every 6 hours - about 6.25 mg/kg per dose, not 25 mg/kg at once. Beyond the neonatal period: 50 mg/kg daily in 4 divided doses, or 50-100 mg/kg daily in 4 divided doses for severe infection, maximum 4,000 mg/day. Adjust to plasma concentrations of 15-25 mcg/mL in children; above 25 mcg/mL is toxic.", "peds_min_weight_kg": null, "peds_max_weight_kg": null, "peds_age_min_months": null, "peds_age_max_months": null, "peds_age_bands": null, "peds_doses": null, "brands": [ { "trade_name": "CIDOCETINE SUCCINATE 1GM VIAL", "scientific_name": null, "normalized_ingredient": null, "manufacturer": "CID", "price_egp": 5.0, "pack_count": null, "unit_price": null, "strength_mg": 1000.0, "exact_strength": true, "exact_form": true, "discontinued": false, "also_contains": null } ], "condition_id": "meningitis-suspected" } ] }