Meningitis medical therapy

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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]

Medical Therapy

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.^[1]^[2]^[3]

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.

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.^[4]

↑ van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (2006) Community-acquired bacterial meningitis in adults. N Engl J Med 354 (1):44-53. DOI:10.1056/NEJMra052116 PMID: 16394301
↑ Edmond K, Clark A, Korczak VS, Sanderson C, Griffiths UK, Rudan I (2010) Global and regional risk of disabling sequelae from bacterial meningitis: a systematic review and meta-analysis. Lancet Infect Dis 10 (5):317-28. DOI:10.1016/S1473-3099(10)70048-7 PMID: 20417414
↑ Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39 (9):1267-84. DOI:10.1086/425368 PMID: 15494903
↑ van de Beek, D.; Brouwer, MC.; Thwaites, GE.; Tunkel, AR. (2012). "Advances in treatment of bacterial meningitis". Lancet. 380 (9854): 1693–702. doi:10.1016/S0140-6736(12)61186-6. PMID 23141618. Unknown parameter |month= ignored (help)