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Meningitis Main Page
Patient Information
Overview
Causes
Classification Viral Meningitis Bacterial Meningitis Fungal Meningitis
Differential Diagnosis
Diagnosis
Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Medical Therapy

Empiric Treatment

• Do not wait for the results of the CT scan and the lumbar puncture; empiric treatment should be started as soon as possible.
• Blood cultures should be drawn before starting the antibiotic therapy, and then the antibiotic treatment should be changed once the blood culture results are out.

• Empiric antibiotic treatment should be started within 30 minutes after the patient presentation.
• In case of high suspicion of pneumococcal meningitis in adult patients, 0.15 mg/kg IV Q6H dexomethasone should be administered for 2 to 4 days.
  • The first dose of dexomethasone is given along with or 20 minutes prior to starting the antibiotics treatment.

Age <1 Week Preferred Regimen ▸ Ampicillin 50 mg/kg IV q8h AND ▸ Cefotaxime 100—150 mg/kg/day IV q8—12h Alternative Regimen ▸ Ampicillin 50 mg/kg IV q8h AND ▸ Gentamicin 2.5 mg/kg IV q12h Age >50 years Preferred Regimen ▸ Vancomycin 30–60 mg/kg per day IV8–12 h AND ▸ Cefotaxime 8–12 g per day IV q4–6h OR ▸'Ceftriaxone 2 g IV q12 h

Age 1—4 Weeks Preferred Regimen ▸ Ampicillin 200 mg/kg/day IV q6—8h AND ▸ Cefotaxime 150—200 mg/kg/day IV q6—8h Alternative Regimen ▸ Ampicillin 200 mg/kg/day IV q6—8h AND ▸ Gentamicin 2.5 mg/kg IV q8h OR ▸ Tobramycin2.5 mg/kg IV q8h OR ▸ Amikacin 10 mg/kg IV q8h Immunocompromised state Preferred Regimen ▸ Vancomycin 30–60 mg/kg per day IV 8–12 h AND ▸ Ampicillin 2 g IV q4 h AND ▸ Cefepime 2 g IV q8 h OR ▸Meropenem 2 g IV q8 h

Age 1—23 Months Preferred Regimen ▸ Vancomycin 15 mg/kg IV q6 h AND ▸ Cefotaxime 225–300 mg/kg per day IV q6–8 h OR ▸ Ceftriaxone 80–100 mg/kg per day IV q12–24 h¤ Recurrent Preferred Regimen ▸ Vancomycin 30–60 mg/kg per day IV8–12 h AND ▸ Cefotaxime 8–12 g per day IVq4–6h OR ▸'Ceftriaxone 2 g IV q12 h

Age 2–50 years Preferred Regimen ▸ Children's dosage is as shown left,shown below is the adult ▸ Vancomycin 30–60 mg/kg per day IV8–12 h AND ▸ Cefotaxime 8–12 g per day IVq4–6h OR ▸ Ceftriaxone 2 g IV q12 h¤ ¤Add amoxicillin or ampicillin if meningitis caused by L monocytogenes is also suspected. ampicillin if meningitis caused by L monocytogenes is also suspected. fhjdskjfkds