Sandbox/v31

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], Sheng Shi, M.D. [3]

Empiric Therapy

Community-Acquired Meningitis

▸   Newborn, Age <1 Week

Newborn, Age <1 Week Preferred Regimen ▸ Ampicillin 50 mg/kg IV q8h PLUS ▸ Cefotaxime 100—150 mg/kg/day IV q8—12h Alternative Regimen ▸ Ampicillin 50 mg/kg IV q8h PLUS ▸ Gentamicin 2.5 mg/kg IV q12h

▸   Newborn, Age 1—4 Weeks

Newborn, Age 1—4 Weeks Preferred Regimen ▸ Ampicillin 200 mg/kg/day IV q6—8h PLUS ▸ Cefotaxime 150—200 mg/kg/day IV q6—8h Alternative Regimen ▸ Ampicillin 200 mg/kg/day IV q6—8h PLUS ▸ Gentamicin 2.5 mg/kg IV q8h OR ▸Tobramycin2.5 mg/kg IV q8h OR ▸ Amikacin 10 mg/kg IV q8h

▸   Infant & Children

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

▸   Adult, Age <50 Years

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 PLUS ▸ 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.

▸   Adult, Age >50 Years

Adult, Age >50 Years Preferred Regimen ▸ Vancomycin 30–60 mg/kg/day IV q8–12h PLUS ▸ Ampicillin 2 g IV q4h PLUS ▸ Cefotaxime 8–12 g/day IV q4–6h OR ▸Ceftriaxone 2 g IV q12h

▸   Immunocompromised

Immunocompromised Preferred Regimen ▸ Vancomycin 30–60 mg/kg/day IV q8–12h PLUS ▸ Ampicillin 2 g IV q4h PLUS ▸ Cefepime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h

▸   Recurrent

Recurrent Preferred Regimen ▸ Vancomycin 30—60 mg/kg/day IV q8–12h PLUS ▸ Cefotaxime 8–12 g/day IV q4–6h OR ▸Ceftriaxone 2 g IV q12h

Healthcare-Associated Meningitis

Basilar Skull Fracture Preferred Regimen ▸ Vancomycin 30—60 mg/kg/day IV q8–12h PLUS ▸ 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 PLUS ▸ Ceftazidime 2 g IV q8 h OR ▸ Cefepime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h

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

References

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