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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

• Adjunctive Dexamethasone (0.15 mg/kg IV q6h for 2—4 days) is recommended for both children and adult patients with acute bacterial meningitis.

Community-Acquired Meningitis

Newborn, 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 Newborn, 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 Infant and Children† Preferred Regimen ▸ Vancomycin 15 mg/kg IV q6h to achieve serum trough concentrations of 15–20 μg/mL AND ▸ Cefotaxime 225—300 mg/kg/day IV q6–8h OR ▸Ceftriaxone 80—100 mg/kg/day IV q12–24h

Adult, Age <50 Years† Preferred Regimen ▸ Vancomycin 30–60 mg/kg/day IV q8–12h to achieve serum trough concentrations of 15–20 μg/mL AND ▸ Cefotaxime 8–12 g/day IV q4–6h OR ▸Ceftriaxone 2 g IV q12h Adult, Age >50 Years Preferred Regimen ▸ Vancomycin 30–60 mg/kg/day IV q8–12h AND ▸ Ampicillin 2 g IV q4h AND ▸ Cefotaxime 8–12 g/day IV q4–6h OR ▸Ceftriaxone 2 g IV q12h Immunocompromised Preferred Regimen ▸ Vancomycin 30–60 mg/kg/day IV q8–12h AND ▸ Ampicillin 2 g IV q4h AND ▸ Cefepime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h Recurrent Preferred Regimen ▸ Vancomycin 30—60 mg/kg/day IV q8–12h AND ▸ Cefotaxime 8–12 g/day IV q4–6h OR ▸Ceftriaxone 2 g IV q12h

^†Add Ampicillin 2 g IV q4h (50 mg/kg IV q6h for children) if meningitis caused by Listeria monocytogenes is also suspected.

Adapted from Advances in treatment of bacterial meningitis. Lancet. 2012;380(9854):1693-702.

Healthcare-Associated Meningitis

Basilar Skull Fracture Preferred Regimen ▸ Vancomycin 30—60 mg/kg/day IV q8–12h AND ▸ Cefotaxime 8–12 g/day IV q4–6h OR ▸ Ceftriaxone 2 g IV q12h Head Trauma; Post-Neurosurgery Preferred Regimen ▸ Vancomycin 30—60 mg/kg/day IV q8–12h AND ▸ Ceftazidime 2 g IV q8 h OR ▸ Cefepime 2 g IV q8h ▸ Meropenem 2 g IV q8h References