Sandbox/v45

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Empiric Therapy Adapted from Lancet. 2012;380(9854):1693-702.[1] and N Engl J Med. 2010;362(2):146-54.[2]

Click on any of the categories below to expand the treatment section.

Community-Acquired

  ▸  Newborns, Age <1 Week

  ▸  Newborns, Age 1—4 Weeks

  ▸  Infants & Children

  ▸  Adults, Age <50 Years

  ▸  Adults, Age >50 Years

  ▸  Immunocompromised

  ▸  Recurrent

Nosocomial

  ▸  Postneurosurgical Infection

  ▸  CSF Shunt Infection

  ▸  Penetrating Trauma

  ▸  Basilar Skull Fracture

Newborns, Age <1 Week
Preferred Regimen
Ampicillin 50 mg/kg IV q8h
PLUS
Cefotaxime 50 mg/kg IV q8—12h
Alternative Regimen
Ampicillin 50 mg/kg IV q8h
PLUS
Gentamicin 2.5 mg/kg IV q12h
Newborns, Age 1—4 Weeks
Preferred Regimen
Ampicillin 200 mg/kg/day IV q6—8h
PLUS
Cefotaxime 50 mg/kg IV q6—8h
Alternative Regimen
Ampicillin 200 mg/kg/day IV q6—8h
PLUS
Gentamicin 2.5 mg/kg IV q8h
OR
Tobramycin 2.5 mg/kg IV q8h
OR
Amikacin 10 mg/kg IV q8h
Infants & Children
Preferred Regimen
Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL)
PLUS
Cefotaxime 75 mg/kg IV q6—8h
OR
Ceftriaxone 80—100 mg/kg/day IV q12—24h
Alternative Regimen
Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL)
PLUS
Meropenem 40 mg/kg IV q8h
Add Ampicillin 75 mg/kg IV q6h if suspecting Listeria monocytogenes.
Adults, Age <50 Years
Preferred Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
Alternative Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Meropenem 2 g IV q8h
Add Ampicillin 2 g IV q4h if suspecting Listeria monocytogenes.
Adults, Age >50 Years
Preferred Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
PLUS
Ampicillin 2 g IV q4h
Alternative Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Aztreonam 2 g IV q6—8h
PLUS
TMP/SMZ 5 mg/kg IV q6—12h (TMP component)
Immunocompromised
Preferred Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Cefepime 2 g IV q8h
OR
Meropenem 2 g IV q8h
PLUS
Ampicillin 2 g IV q4h
Recurrent
Preferred Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
Postneurosurgical Infection
Preferred Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Cefepime 2 g IV q8h
OR
Ceftazidime 2 g IV q8h
OR
Meropenem 2 g IV q8h
Alternative Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Aztreonam 2 g IV q6—8h
OR
Ciprofloxacin 400 mg IV q8—12h
CSF Shunt Infection
Preferred Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Cefepime 2 g IV q8h
OR
Ceftazidime 2 g IV q8h
OR
Meropenem 2 g IV q8h
Alternative Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Aztreonam 2 g IV q6—8h
OR
Ciprofloxacin 400 mg IV q8—12h
Penetrating Trauma
Preferred Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Cefepime 2 g IV q8h
OR
Ceftazidime 2 g IV q8h
OR
Meropenem 2 g IV q8h
Alternative Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Aztreonam 2 g IV q6—8h
OR
Ciprofloxacin 400 mg IV q8—12h
Basilar Skull Fracture
Preferred Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
Alternative Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Aztreonam 2 g IV q6—8h
OR
Ciprofloxacin 400 mg IV q8—12h


References

  1. 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)
  2. van de Beek, D.; Drake, JM.; Tunkel, AR. (2010). "Nosocomial bacterial meningitis". N Engl J Med. 362 (2): 146–54. doi:10.1056/NEJMra0804573. PMID 20071704. Unknown parameter |month= ignored (help)