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Bacterial Meningitis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Definition

• Bacterial meningitis is the infection of meninges by bacteria.

Empiric Therapy

Negative CSF Gram Stain

Group	Etiology	Preferred Regimen	Alternative Regimen
Preterm—1 mo	Streptococcus agalactiae (49%) Escherichia coli (18%) misc. Gram-positive (10%) misc. Gram-negative (10%) Listeria (7%)	Drug A PLUS Drug B	Drug C PLUS Drug D
1 mo—50 yrs	Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae†	Cefotaxime 2 gm IV q4—6h OR Ceftriaxone 2 gm IV q12h PLUS Vancomycin 500—750 mg IV q6h‡ PLUS Dexamethasone
123	123	123	123

^† H. influenzae now very rare, listeria unlikely if young & immuno-competent (add ampicillin if suspect listeria: 2 gm IV q4h)

^‡ Children’s dosage 15 mg/kg IV q6h (2x standard adult dose)

References

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