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==CSF Gram Stain-Based Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Lancet. 2012;380(9854):1693-702.''<ref name="van de Beek-2012">{{Cite journal  | last1 = van de Beek | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = Thwaites | first3 = GE. | last4 = Tunkel | first4 = AR. | title = Advances in treatment of bacterial meningitis. | journal = Lancet | volume = 380 | issue = 9854 | pages = 1693-702 | month = Nov | year = 2012 | doi = 10.1016/S0140-6736(12)61186-6 | PMID = 23141618 }}</ref> and ''Clin Infect Dis. 2004;39(9):1267-84.''<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==


{|
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Gram-Positive'''
</font>
</div>
<div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive Cocci in Chains'''
</font>
</div>


<div class="mw-customtoggle-table18" style="cursor:pointer;  
<div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive Cocci in Pairs'''
</font>
</div>


background: #4479BA;
<div class="mw-customtoggle-table14" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive (Cocco-)Bacilli'''
</font>
</div>


border-radius: 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 0 rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5);
<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Gram-Negative'''
</font>
</div>


height: 30px; line-height: 30px; width: 225px"><font color="#FFF">&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Acinetobacter baumannii'''''</font></div>
<div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Cocci in Pairs'''
</font>
</div>


<div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Coccobacilli'''
</font>
</div>


<div class="mw-customtoggle-table17" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Bacilli'''
</font>
</div>


{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table18" style="border: 2px solid #696969;"
| valign=top |
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Positive Cocci in Chains}}
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''
|-
|}
|}
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Positive Cocci in Pairs}}
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h'''''
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
|}
|}
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table14" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Positive (Cocco-)Bacilli}}
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h'''''
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
|-
|}
|}
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background: #FFFFFF;"
| valign=top |
| valign=top |
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;"
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''Acinetobacter baumannii''}}
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Negative Cocci in Pairs}}
|-
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Colistin]] 1.25 mg/kg IV q6—12h'''''<BR> OR <BR> ▸ '''''[[Polymyxin B]] 0.75—1.25 mg/kg IV q12h'''''
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''
|-
|-
|}
|}
|}
|}
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Negative Coccobacilli}}
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''
|-
|}
|}
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table17" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Negative Bacilli}}
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL>
|-
|}
|}
|}
==References==
{{Reflist|2}}

Latest revision as of 06:52, 26 January 2014

CSF Gram Stain-Based Therapy Adapted from Lancet. 2012;380(9854):1693-702.[1] and Clin Infect Dis. 2004;39(9):1267-84.[2]

Gram-Positive

  ▸  Gram-Positive Cocci in Chains

  ▸  Gram-Positive Cocci in Pairs

  ▸  Gram-Positive (Cocco-)Bacilli

Gram-Negative

  ▸  Gram-Negative Cocci in Pairs

  ▸  Gram-Negative Coccobacilli

  ▸  Gram-Negative Bacilli

Gram-Positive Cocci in Chains
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Cefotaxime 2 g IV q4—6h
OR
▸ Ceftriaxone 2 g IV q12h
Alternative Regimen
▸ Meropenem 2 g IV q8h
OR
▸ Moxifloxacin 400 mg IV q24h
Gram-Positive Cocci in Pairs
Preferred Regimen
▸ Ampicillin 2 g IV q4h
OR
▸ Penicillin G 4 MU IV q4h
PLUS
▸ Gentamicin 1.7 mg/kg IV q8h
Alternative Regimen
▸ Cefotaxime 2 g IV q4—6h
OR
▸ Ceftriaxone 2 g IV q12h
Gram-Positive (Cocco-)Bacilli
Preferred Regimen
▸ Ampicillin 2 g IV q4h
OR
▸ Penicillin G 4 MU IV q4h
PLUS
▸ Gentamicin 1.7 mg/kg IV q8h
Alternative Regimen
▸ TMP/SMZ 5 mg/kg IV q6—12h (TMP component)
OR
▸ Meropenem 2 g IV q8h
Gram-Negative Cocci in Pairs
Preferred Regimen
▸ Cefotaxime 2 g IV q4—6h
OR
▸ Ceftriaxone 2 g IV q12h
Alternative Regimen
▸ Penicillin G 4 MU IV q4h
OR
▸ Ampicillin 2 g IV q4h
OR
▸ Chloramphenicol 1—1.5 g IV q6h
OR
▸ Moxifloxacin 400 mg IV q24h
OR
▸ Aztreonam 2 g IV q6—8h
Gram-Negative Coccobacilli
Preferred Regimen
▸ Cefotaxime 2 g IV q4—6h
OR
▸ Ceftriaxone 2 g IV q12h
Alternative Regimen
▸ Chloramphenicol 1—1.5 g IV q6h
OR
▸ Cefepime 2 g IV q8h
OR
▸ Meropenem 2 g IV q8h
OR
▸ Moxifloxacin 400 mg IV q24h
Gram-Negative Bacilli
Preferred Regimen
▸ Cefotaxime 2 g IV q4—6h
OR
▸ Ceftriaxone 2 g IV q12h
Alternative Regimen
▸ Cefepime 2 g IV q8h
OR
▸ Meropenem 2 g IV q8h
OR
▸ Aztreonam 2 g IV q6—8h
OR
▸ Moxifloxacin 400 mg IV q24h
OR
▸ TMP/SMZ 5 mg/kg IV q6—12h (TMP component)


References

  1. ↑ van de Beek, D.; Brouwer, MC.; Thwaites, GE.; Tunkel, AR. (2012). "Advances in treatment of bacterial meningitis". Lancet. 380 (9854): 1693–702. doi:10.1016/S0140-6736(12)61186-6. PMID 23141618. Unknown parameter |month= ignored (help)
  2. ↑ Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39 (9):1267-84. DOI:10.1086/425368 PMID: [1]
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