Sandbox/v30

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]

Overview

• If the suspected patient complaints with fever, headache, altered level of consciousness, signs of meningeal irritationthe, blood culture or CSF should be obtained urgently, then CT. But 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.

Empiric Therapy

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.

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 OR ▸ Meropenem 2 g IV q8h

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