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Classification Viral Meningitis Bacterial Meningitis Fungal Meningitis
Differential Diagnosis
Diagnosis
Treatment

Streptococcus pneumoniae

Penicillin MIC ≤0.06 μg/mL Preferred Regimen ▸ Penicillin G Low: 600,000–1.2 million units/day IM ; High:≥ 20 million units IV q24h(=12 gm) OR ▸ Ampicillin 0.25–0.5 gm po q6h.150–200 mg/kg/day IV Alternative Regimen ▸ Cefotaxime 1 gm q8–12h to 2 gm IV q4h OR ▸ Ceftriaxone 1 gm IV qd OR 2 g IV q12h(for Purulent meningitis also IM in 1% lidocaine) OR ▸ Chloramphenicol 0.25–1 gm po IV q6h to max. of 4 gm/day

Penicillin MIC ≥0.12 μg/mL Cefotaxime or Ceftriaxone MIC† <1.0 μg/mL Preferred Regimen ▸ Cefotaxime 1 gm q8–12h to 2 gm IV q4h OR ▸ Ceftriaxone 1 gm IV qd OR 2 g IV q12h(for Purulent meningitis also IM in 1% lidocaine) Alternative Regimen ▸ Cefepime 1–2 gm IV q12h OR ▸ Meropenem 2 gm IV q8h Cefotaxime or Ceftriaxone MIC† >1.0 μg/mL Preferred Regimen ▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h AND ▸ Cefotaxime 1 gm q8–12h to 2 gm IV q4h OR ▸ Ceftriaxone 1 gm IV qdOR 2 g IV q12h(for Purulent meningitis also IM in 1% lidocaine) Alternative Regimen ▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h AND ▸ Moxifloxacin 400 mg po IV q24h

Neisseria meningitidis

Neisseria meningitidis Penicillin MIC <0.1 μg/mL Preferred Regimen ▸ Penicillin G Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 gm) OR ▸ Ampicillin 0.25–0.5 gm po q6h.150–200 mg/kg/day IV Alternative Regimen ▸ Cefotaxime 1 gm q8–12h to 2 gm IV q4h OR ▸ Ceftriaxone 1 gm IV qd OR 2 g IV q12h(for Purulent meningitis also IM in 1% lidocaine) OR ▸ Chloramphenicol 0.25–1 gm po IV q6h to max. of 4 gm/day

Neisseria meningitidis Penicillin MIC ≥0.1 μg/mL Preferred Regimen ▸ Cefotaxime 1 gm q8–12h to 2 gm IV q4h OR ▸ Ceftriaxone 1 gm IV qd OR 2 g IV q12h(for Purulent meningitis also IM in 1% lidocaine) Alternative Regimen ▸ Cefepime 1–2 gm IV q12h OR ▸ Chloramphenicol 0.25–1 gm po IV q6h to max. of 4 gm/day OR ▸ Fluoroquinolone OR ▸ Meropenem 2 gm IV q8h

Listeria Monocytogenes and Streptococcus agalactiae

Listeria Monocytogenes Preferred Regimen ▸ Ampicillin 0.25–0.5 gm po q6h.150–200 mg/kg/day IV OR ▸ Penicillin G Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 gm) Alternative Regimen ▸ Trimethoprim-sulfamethoxazole 5–20 mg/kg/day q6-12h

Streptococcus agalactiae Preferred Regimen ▸ Ampicillin 0.25–0.5 gm po q6h.150–200 mg/kg/day IV OR ▸ Penicillin G Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 gm) Alternative Regimen ▸ Cefotaxime 1 gm q8–12h to 2 gm IV q4h OR ▸ Ceftriaxone 1 gm IV qd OR 2 g IV q12h(for Purulent meningitis also IM in 1% lidocaine) OR ▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h

Haemophilus influenzae

Haemophilus influenzae β-lactamase negative Preferred Regimen (Adult) ▸ Ampicillin 0.25–0.5 gm po q6h.150–200 mg/kg/day IV Alternative Regimen (Adult) ▸ Cefotaxime 1 gm q8–12h to 2 gm IV q4h OR ▸ Ceftriaxone 1 gm IV qd OR 2 g IV q12h(for Purulent meningitis also IM in 1% lidocaine) OR ▸ Cefepime 1–2 gm IV q12h OR ▸ Chloramphenicol 0.25–1 gm po IV q6h to max. of 4 gm/day OR ▸ Aztreonam 1 gm q8h–2 gm IV q6h OR ▸ Fluoroquinolone

Haemophilus influenzae β-lactamase positive Preferred Regimen ▸ Cefotaxime 1 gm q8–12h to 2 gm IV q4h OR ▸ Ceftriaxone 1 gm IV qd OR 2 g IV q12h(for Purulent meningitis also IM in 1% lidocaine) Alternative Regimen ▸ Cefepime 1–2 gm IV q12h OR ▸ Chloramphenicol 0.25–1 gm po IV q6h to max. of 4 gm/day OR ▸ Aztreonam 1 gm q8h–2 gm IV q6h OR ▸ Fluoroquinolone

Haemophilus influenzae β-lactamase negative, ampicillin resistant Preferred Regimen ▸ Meropenem 2 gm IV q8h Alternative Regimen ▸ Fluoroquinolone

Staphylococcus aureus

Staphylococcus aureus Meticillin sensitive Preferred Regimen ▸ Nafcillin 1–2 gm IV/IM q4h OR ▸ Oxacillin 1–2 gm IV/IM q4h Alternative Regimen ▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h OR ▸ linezolid 600 mg IV/PO q12h OR ▸ Daptomycin

Staphylococcus aureus Meticillin resistant Preferred Regimen ▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h Alternative Regimen ▸ Trimethoprim-sulfamethoxazole 5–20 mg/kg/day q6-12h OR ▸ linezolid 600 mg IV/PO q12h OR ▸ Daptomycin

Staphylococcus epidermidis and Acinetobacter baumannii

Staphylococcus epidermidis Preferred Regimen ▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h Alternative Regimen ▸ Linezolid 600 mg IV/PO q12h Acinetobacter baumannii Preferred Regimen ▸ Meropenem 2 gm IV q8h Alternative Regimen ▸ Colistin OR ▸ Polymyxin B 15,000–25,000 units/kg/day q12h Enterobacteriaceae and Pseudomonas aeruginosa Enterobacteriaceae Preferred Regimen ▸ Cefotaxime 1 gm q8–12h to 2 gm IV q4h OR ▸ Ceftriaxone 1 gm IV qd OR 2 g IV q12h(for Purulent meningitis also IM in 1% lidocaine) Alternative Regimen ▸ Aztreonam 1 gm q8h–2 gm IV q6h OR ▸ Fluoroquinolone OR ▸ Trimethoprim-sulfamethoxazole OR ▸ Meropenem 2 gm IV q8h OR ▸ Ampicillin 0.25–0.5 gm po q6h.150–200 mg/kg/day IV Pseudomonas aeruginosa Preferred Regimen ▸ Ceftazidime 1–2 gm IV/IM q8–12h OR ▸ Cefepime 1–2 gm IV q12h Alternative Regimen ▸ Aztreonam 1 gm q8h–2 gm IV q6h OR ▸ Meropenem 2 gm IV q8h OR ▸ Ciprofloxacin 500-750 mg po bid