Meningitis medical therapy

	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]

Overview

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.

Shown below is a table summarizing the preferred and alternative empiric treatment for meningitis.

Characteristics of the Patient	Possible Pathogens	Preferred Treatment	Duration of Treatment	Alternative Treatment
Immunocompentent patient Age<50	Streptococcus pneumonia Nisseria meningitis Hemophilus influenzae	Vancomycin Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Ceftriaxone 2 g IV Q12H	Stop or adjust treatment choice and duration when the results of the lumbar puncture are out	In case of penicillin allergy: Chloramphenicol + Vancomycin
Immunocompentent patient Age>50
Immunocompromised patient
Patient with history of penetrating head trauma or neurosurgery
Shunt infection