health canada-approved treatments: meningitis
19 minute read
current meningitis therapies are used to stop the infection from causing severe complications, including disability and death.
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this article is for informational purposes only and is not intended to provide medical advice, diagnosis or treatment. always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
meningitis is the inflammation of the membranes, known as the meninges, and fluid surrounding the spinal cord and brain. it can be caused by viruses, bacteria, parasites, and fungi, but it is most often caused by a viral infection.
when it is caused by a virus, it is often mild and can clear up on its own without treatment. some possible viral causes include:
- herpes simplex
- hiv
- mumps
- west nile
several types of bacteria can cause meningitis as well. they include:
- neisseria meningitidis
- streptococcus pneumoniae
- hemophilus influenzae type b
- listeria monocytogenes
- streptococcus agalactiae
- mycobacterium tuberculosis
- salmonella
- staphylococcus
most invasive meningitis cases, or those more severe in nature, are associated with neisseria meningitidis serogroups a, b, c, y and w.
fungal infections can cause chronic meningitis, a long-lasting type of the disease. common types of fungi that can lead to meningitis include:
- cryptococcal neoformans
- candida albicans
- histoplasma
three types of parasites are known to cause most cases of parasitic meningitis, also known as eosinophilic meningitis. they include:
- angiostrongylus cantonensis
- baylisascaris procyonis
- gnathostoma
that said, other parasites, such as tapeworms and amoebic parasites, can also cause meningitis.
other rare causes of meningitis include injuries, some cancers and certain drugs or medications.
although anyone can contract a pathogen that causes meningitis, young children and infants are the most at risk. other factors that increase risk include:
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- having certain diseases, such as sickle cell disease or anatomic asplenia
- living with congenital immunodeficiencies
- having acquired complement deficiency through the use of certain drugs
- living with hiv
- traveling to areas with higher rates of infection
- working in research, industrial or clinical laboratory settings
- frequently being in close contact with individuals with meningitis (healthcare workers, etc.)
those living in crowded conditions, such as refugee camps and student or military housing, also experience a higher risk of meningitis because it makes transmission easier.
the mode of transmission differs depending on the pathogen that causes meningitis. in bacterial cases, people can contract it through throat secretions or respiratory droplets. in some cases, a mother can pass on a bacterial infection to her child at birth.
when someone develops meningitis, they can experience symptoms that range in severity. in the early stages, the infection may resemble the flu and present with similar symptoms, but as it progresses, the symptoms worsen.
in people over the age of two years old, symptoms can include:
- a high fever that comes on suddenly
- stiff neck
- a severe headache
- gastrointestinal distress, including nausea or vomiting
- cognitive changes, such as difficulty concentrating or confusion
- seizures
- difficulty waking up or feeling sleepiness
- increased sensitivity to light
- reduced or nonexistent feelings of hunger or thirst
- skin rashes
in those under the age of two and newborns, the infection may present differently. symptoms in this age group include:
- high fever
- trouble waking from sleep, feeling excessively sleepy or irritable
- being inactive or sluggish
- poor feeding and not waking up to feed
- vomiting
- stiffness in the neck and body
- constant crying or crying harder when held
- a bulge in the soft spots (fontanels) on the baby’s head
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since the infection can be severe in nature, people who experience any of the symptoms of meningitis should head to the nearest emergency room. meningitis, without prompt treatment, can lead to permanent brain damage or death in only a few days.
aftereffects or complications may also arise in those who contract a meningitis-causing pathogen, such as hearing loss, seizures, limb weakness, vision, speech and language difficulties, memory problems and issues with communication. in those who develop meningitis-driven sepsis (a blood infection) scarring, and limb amputation may also occur. prompt treatment can help reduce the risk of these complications.
this article explores the preventive measures and treatment options available for canadians who contract meningitis.
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preventive measures
vaccines are available to help protect canadians against the development of meningitis. they are geared toward specific pathogens that drive infectious disease. several are available, each designed to reduce the risk of a person developing severe meningitis.
monovalent conjugate meningococcal vaccines (men-c-c)
monovalent conjugate meningococcal vaccines protect against neisseria meningitidis serogroup c. there are currently two available in canada:
- menjugate liquid
- neisvac-c vaccine
infants should receive one vaccine dose before they reach 12 months of age and again between the ages of 12 and 23 months. in children who were not immunized in infancy, the dose can be given between the ages of five and 11. another dose is given between the ages of 12 and 24, routinely at age 12.
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quadrivalent conjugate meningococcal vaccines (men-c-acyw)
quadrivalent conjugate meningococcal vaccines can be used to protect against groups a, c, y, and w meningococcal infections. those approved in canada include:
- menactra
- menvio
- nimenrix
- menquadfi
these vaccines use the same dosing schedule as the men-c-c vaccines. they are also recommended as boosters for those at higher risk of developing meningitis, alongside other meningitis vaccines.
serogroup b meningococcal vaccines
two serogroup b meningococcal vaccines are currently approved for use in canada to protect against meningitis infections. they include:
- bexsero (4cmenb)
- trumenba (menb-fhbp)
these vaccines are often used alongside other types as a form of added protection against bacterial meningitis. menb-fhbp vaccines are often used together in people aged ten years or older, and 4cmenb vaccines can be used alongside men-c-c and men-c-acyw vaccines during routine vaccinations in the schedule above or as recommended based on a healthcare provider’s considerations of a person’s individual risk and local epidemiology.
vaccine schedule for high-risk individuals
the vaccine schedule changes for those at a higher risk. between the ages of two and 11 months, an infant should be given two or three doses eight weeks apart using men-c-acyw-crm or 4cmenb vaccines.
two doses of men-c-acyw-crm and 4cmenb should be administered at least eight weeks apart to children aged 12 to 12 months.
at 24 months to nine years of age, two more doses should be given using men-c-acyw and 4cmenb vaccines. after the age of 10, the dosing schedule is as follows:
- two doses of men-c-acyw given eight weeks apart or
- two doses of 4cmenb given at least four weeks apart or
- three doses of menb-fhbp given at least four weeks apart, with a fourth dose given four months after the second dose and six months after the first dose
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other special considerations should be taken into account when choosing when to get a meningitis vaccine for high-risk people.
a booster shot should be considered every three to five years if a person was vaccinated at age six or younger and every five years if a person was seven or older when vaccinated.
if an infant is given a vaccine dose using 4cmenb between two and five months of age, they can be given three doses, but only two doses should be given if the first dose was given between the ages of six and 11 months.
if the immunization process needs to be sped up for any reason, the men-c-acyw vaccine can be given four weeks apart.
serogroup b meningococcal vaccines are not authorized for use in people over the age of 26, and men-c-acyw vaccines are not authorized for use in people over the age of 56. that said, they can be considered in special cases based on the clinical evidence and the advice of experts.
people should also update their vaccinations in certain circumstances, such as travelling to high-risk areas or having underlying medical conditions that may make them more susceptible to developing meningitis.
people living in overcrowded conditions, especially military personnel who travel to high-risk areas and live in close quarters with other people, should get a booster dose of the men-c-acyw vaccine every five years. those at risk in research and clinical laboratory positions should also get booster doses of the same vaccine every five years.
all meningitis vaccines are given in 0.5 ml doses and administered intramuscularly (im).
potential side effects and contraindications
while these vaccines are considered safe, there is some evidence of side effects occurring. for men-c-acyw vaccinations, people can experience injection site reactions at a rate of 59 per cent, fever at a rate of five per cent, and headaches and malaise at a rate of 60 per cent.
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those who were given men-c-c vaccines may also experience mild reactions at a rate of 50 per cent. for infants, 80 per cent develop irritability and nine per cent develop fever. in older children and adults, headaches and malaise were side effects seen at a rate of 10 per cent.
serogroup b vaccines also presented with some side effects in clinical trials. for the 4cmenb vaccine, injection site tenderness, sleepiness, and irritability were seen, as well as fever.
in the menb-fhbp vaccine, injection site tenderness and irritability were the most common side effects.
according to health canada, severe side effects were so seldom reported that data is insufficient to determine an association to the vaccines.
people who experience severe allergic reactions to any of the meningitis vaccines should refrain from getting another unless given in a controlled setting supervised by a healthcare provider and after consultation with an allergist.
people who are ill, either moderately or severely, should also delay vaccination.
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prescription medications
prescription medications can be used to treat current cases of meningitis and prevent the infection from being passed to people who have had close contact with a confirmed case.
antibiotics
antibiotics are used for bacterial meningitis cases. these drugs can work in two ways: killing bacteria or stopping them from multiplying so they can no longer do any damage to cells in the body. the antibiotics often used for meningitis in canada include:
- penicillin g at a dose of 300,000 to 400,000 units per kg of body weight per day divided into doses every four to six hours
- ampicillin at a dose of 300 mg per kg of body weight per day divided into doses every four to six hours
- ceftriaxone at a dose of 100mg per kg of body weight per day divided into doses every 12 hours
- cefotaxime at a dose of 300 mg per kg of body weight per day divided into doses every four to six hours
- meropenem at a dose of 120 mg per kg of body weight per day divided into doses every four to six hours
- vancomycin 60 mg per kg of body weight per day divided into doses every four to six hours
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gentamicin, another antibiotic, can be used alongside penicillin or ampicillin for the first five-to-seven days of treatment for a specific type of bacteria, streptococcus agalactia.
penicillin is the first-line therapy, but in the event that a person cannot take penicillin or the bacteria is resistant to that treatment, they are offered other types of antibiotics in its place.
all antibiotic therapy is administered intravenously for meningitis for a period of 10 to 14 days for uncomplicated cases caused by streptococcal pneumoniae; five to seven days for cases caused by neisseria meningitidis; and 14 to 21 days for uncomplicated cases of streptococcus agalactiae cases.
people undergoing extensive antibiotic therapy may have to contend with side effects. they include:
- rash
- itchiness
- diarrhea
- abnormal kidney or liver lab tests
- nausea
- yeast infections
- severe allergic reactions
- clostridium difficile, an infection in the gastrointestinal tract that can lead to colon damage or death
taking antibiotics can also lead to antibiotic resistance, in which bacteria become stronger against the medications designed to kill them. this could, in the future, lead to more difficulties in treating bacterial infections within the body.
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chemoprophylaxis agents
if a person comes into contact with a confirmed case of meningitis but has not yet been diagnosed with the infection, they may be given chemoprophylaxis agents to help prevent an infection from occurring. these can be given regardless of someone’s vaccination status.
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these agents work by eradicating the colonization of the bacteria, specifically neisseria meningitidis, to prevent them from getting further into the body to cause disease as well as prevent further transmission.
this type of prevention is typically used for close contacts where there is a strong indication that they may have infectious droplets in their nasal cavity. it should be given as soon as possible in the first 24 hours after exposure. however, it can still be given for up to 10 days, the standard incubation period for meningitis.
exceptions of individuals who are not given chemoprophylaxis agents for meningitis contact include:
- healthcare workers
- emergency workers
- social or workplace associates
- school or classroom contacts
close contacts may also be given antibiotics alongside chemoprophylaxis agents.
there are three specific agents given in canada:
- rifampin
- ciprofloxacin
- ceftriaxone
rifampin can be given to people of all ages but in different doses. infants under the age of one month can take 5mg/kg of body weight of rifampin for a maximum of 4 doses. children over the age of one month and younger than 18 years can take 10mg/kg of body weight for a maximum of 4 doses, and adults over 18 can take 600 mg for a maximum of four doses.
infants who are born premature or have jaundice should not be given rifampin, and those who are pregnant should only do so under the advice of a physician.
these drugs should also be avoided in those taking hiv antiretroviral drugs, those with a history of allergic reaction to the ingredients, or those taking other drugs that are metabolized through a similar pathway, known as the cytochrome p-450 system. the drug may also interfere with the effectiveness of contraceptives containing estrogen.
side effects of rifampin can include the staining of urine, tears, sputum, or sweat, which may turn an orange-red color.
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ciprofloxacin is given to those over the age of 18 at a single dose of 500 mg and should not be given to those who are pregnant, breastfeeding, or under 18. people who have hypersensitivities to fluoroquinolone drugs should also avoid rifampin.
while taking ciprofloxacin, it’s important to refrain from using antacids and iron products. side effects can include dizziness or lightheadedness.
ceftriaxone is used in people of all ages. those over age 12 can take a single dose of 250 mg, whereas those under 12 can take a single dose of 125 mg. people who are hypersensitive to penicillin or local anesthetic products should avoid ceftriaxone.
pregnant women can safely take ceftriaxone, and it’s also often recommended for people who cannot take oral medications.
some possible side effects include diarrhea and other gastrointestinal upset, and pain, tenderness, or swelling at the injection site.
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steroids as adjuvant therapy
research suggests that using steroids as an additional therapeutic measure can reduce the risk of death as well as hearing loss in some cases. the steroid used is dexamethasone.
dexamethasone is an oral corticosteroid that acts as a natural steroid. it is typically used to treat various health conditions in which the levels of natural steroids are depleted. these include inflammatory arthritis and intestinal disorders, severe allergies, and asthma. in some cases, it may also be used to treat certain types of cancer.
the steroids have the most benefit when administered alongside antibiotics within 24 to 48 hours of suspecting or confirming a case of meningitis. these drugs should be given just before or within two hours of the antibiotic dose and should be continued for up to four days.
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however, if treatment is not sought within the 48-hour period, steroids should not be used as an additional treatment.
the dose for these drugs is .06 mg/kg of body weight per day divided into doses administered every six hours before, alongside, or within four hours of giving antibiotics. the earlier the steroids are given, the greater the clinical benefit.
there are also many side effects associated with taking the drug, including:
- gastrointestinal issues, including stomach irritation, vomiting, and upset stomach
- mental changes, including insomnia, restlessness, depression and anxiety
- headaches
- dizziness
- acne
- increased hair growth
- easy bruising
- irregular or absent menstrual periods
serious side effects that require immediate medical attention can include:
- skin rash
- swelling in the face, ankles, or lower legs
- problems with vision
- a long-lasting cold or infection
- muscle weakness
- black or tarry stools
people who are allergic to any of the ingredients in dexamethasone, including tartrazine, a yellow dye used in some foods and drugs, should avoid this medication. other drugs, including anticoagulants such as warfarin, arthritis medications, aspirin, oral contraceptives, diuretics, specific immunosuppressants such as cyclosporine, heart drugs such as digoxin, estrogen, antifungals such as ketoconazole, phenobarbital, phenytoin (dilantin), rifampin (rifadin), theophylline (theo-dur), can interact with dexamethasone, so you should alert your healthcare provider before taking the steroid if you are also taking any of these drugs.
people with certain health conditions, including liver, kidney, intestinal, or heart disease, diabetes, underactive thyroid, high blood pressure, mental illness, myasthenia gravis, osteoporosis, herpes eye infections, seizures, tuberculosis, and ulcers, should also avoid dexamethasone before speaking to their doctor.
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alcohol consumption should also be avoided when taking dexamethasone.
weighing the benefits of the drug alongside the risks is crucial when determining whether it should be used as additional therapy in meningitis due to the adverse effects that can occur when the drug is stopped abruptly. these can include:
- appetite loss and weight loss
- gastrointestinal distress, including upset stomach and vomiting
- confusion
- headaches
- fever
- joint and muscle pain
- peeling skin
these risks are lower in individuals who take low-dose dexamethasone for a shorter period of time, as is the case with those who would take it for meningitis.
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over-the-counter options
over-the-counter (otc) medications may help alleviate some symptoms, but they are not a substitute for proper medical care. if you suspect meningitis, seek medical attention immediately.
acetaminophen
acetaminophen can be used to treat acute pain and fever in people with meningitis. however, this should only be used in certain cases after getting the go-ahead from a doctor.
acetaminophen is an over-the-counter (otc) drug that goes by many names, including tylenol and excedrin. there are over 400 brands of acetaminophen available throughout canada.
when using this drug, it’s crucial to take the appropriate dose. those over the age of 12 should follow the bottle instructions and can take up to 4000 mg in a day. those under 12 are given doses based on age and weight, with instructions provided by the manufacturer.
acetaminophen is a safe drug, but it should be avoided by certain people unless otherwise directed by their healthcare provider. people with liver disease or alcoholism should not take acetaminophen or should take lower doses if a doctor says it’s okay to do so because of the risk of buildup due to the liver being unable to process the drug in normal amounts, leading to a condition known as drug-induced hepatitis.
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while acetaminophen isn’t likely to cause an overdose, taken in too-high amounts can lead to one, causing liver failure or injuries. the signs of an overdose from acetaminophen include:
- gastrointestinal issues such as nausea, vomiting, stomach or abdominal pain, and loss of appetite
- extreme tiredness
- yellowing of the skin or eyes (jaundice)
- dark urine
- increased sweating
these symptoms require immediate medical attention.
non-steroidal anti-inflammatories (nsaids)
nsaids are anti-inflammatory medications that treat pain, swelling, and fever in various conditions, including arthritic diseases and disorders, menstrual pain and infections.
these drugs work by hindering the body’s ability to produce hormone-like chemicals that cause inflammation, fever, and pain.
the two types of nsaids that can be recommended for meningitis include ibuprofen and naproxen, both of which can be found otc or prescribed.
if given in a prescription, ibuprofen is taken orally as a pill or liquid. if found otc, it comes in tablets, chewable tablets, capsules, gel capsules, liquid, or drops. the dose depends on the strength of the medication, and both prescribed and otc versions come with complete instruction packets.
typically, ibuprofen is taken every four to six hours if prescribed and every six to eight hours if otc. no more than four doses should be given in a 24-hour period.
it should also be taken with food or milk to prevent gastrointestinal side effects. the total list of side effects includes:
- constipation
- gas or bloating
- dizziness
- nervousness
- ringing in the ears
some severe side effects can also occur, including:
- unexplained weight gain
- shortness of breath and difficulty breathing
- difficulty swallowing or hoarseness
- swelling of the eyes, face, throat, arms, hands, feet, ankles, lower legs or abdomen
- diarrhea
- itching, rash, hives, blisters or peeling skin
- fever
- appetite loss
- yellowing of the skin or eyes (jaundice)
- flu-like symptoms
- pale skin
- nausea
- urinary issues, including cloudy, discoloured, or bloody urine and difficult or painful urination
- a fast heartbeat
- headaches
- stiff neck
- blurred vision or other vision changes
- back pain
- excessive tiredness
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these require immediate medical attention.
before taking ibuprofen, a person should speak to their doctor if:
- they are allergic to nsaid ingredients
- have various other health conditions, including nasal polyps, heart failure, lupus, liver or kidney disease and phenylketonuria
- they are pregnant or breastfeeding
- they are having surgery
naproxen is another nsaid used to treat fever, pain, or inflammation. it is often used as an additional therapy for those with arthritic conditions, such as osteoarthritis, juvenile arthritis, rheumatoid arthritis, gout and ankylosing spondylitis.
inflammatory conditions, such as tendinitis and bursitis, can also often benefit from naproxen. it can also relieve pain from menstrual cramps, muscle aches, headaches, toothaches, and backaches.
when prescribed, naproxen comes in an oral tablet that is time-released, meaning it releases a little of the drug at a time throughout the body to help prevent intestinal damage. dosing should be followed precisely, and typically, people can take one dose every six to eight hours. extended-release tablets and liquid forms taken orally are also available as prescriptions.
otc naproxen products come in tablets, capsules, and gel capsules. they are typically taken every eight to 12 hours.
people taking naproxen should stop taking it and call their healthcare provider if they experience worsened symptoms or new symptoms. if the area being treated for pain becomes red or swollen or a fever lasts longer than three days, the drug should also be stopped.
taking certain drugs can cause interactions with naproxen, so you should avoid taking naproxen while taking the following medications unless given the go-ahead by your doctor:
- ace inhibitors
- angiotensin receptor blockers
- beta-blockers
- diuretics
- diabetes medications
- methotrexate
- digoxin
- phenytoin
- probenecid
- sulfa medications
- antacids
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those who are pregnant or breastfeeding should avoid naproxen as it can harm a fetus. people who are looking to become pregnant should also avoid naproxen because it can reduce fertility in women.
those eating a low-sodium diet should also speak to their healthcare provider before taking naproxen.
people with certain health conditions should also avoid naproxen unless otherwise directed. conditions include:
- asthma
- nasal polyps
- heart failure
- swelling in the arms, feet, ankles, lower legs or hands
- anemia
- kidney disease
all nsaids, including both ibuprofen and naproxen, come with risks. people who take nsaids regularly and at higher doses are at a greater risk of developing a heart attack or stroke that may lead to death. if you or a person in your family has recently had a heart attack, heart disease, or stroke, smokes cigarettes, or has high cholesterol, high blood pressure, or diabetes, this drug should be avoided.
the signs of these adverse cardiovascular events that require emergency medical attention include:
- chest pain
- shortness of breath
- weakness in one side of the body
- slurred speech
nsaids can also cause gastrointestinal damage, including bleeding, ulcers, or holes in the esophagus. these adverse events can also lead to death.
the risk of both cardiovascular and gastrointestinal issues is higher in people who are over the age of 65, are in generally poor health, drink large amounts of alcohol, or smoke cigarettes.
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treating meningitis in canada
meningitis can be incredibly severe and lead to death, so prompt treatment is of the utmost importance. that said, many people are equipped to handle an infection as they have received vaccinations in infancy, childhood, and early adulthood. the best way to prevent severe illness from meningitis is to get vaccinated early and often enough to protect yourself.
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if you do develop meningitis symptoms, even if you’re vaccinated, it’s crucial to see a health-care provider or head to your nearest emergency department right away. it’s also vital to isolate yourself from others who could contract the infection from you, as most common types can be spread easily through respiratory droplets.
vaccinations to protect against meningitis and the currently available antibiotic and adjuvant therapies aim to treat the infection to prevent the worst-case scenario from occurring, such as death, permanent brain damage and disability.
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