Sandbox/20
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Bacterial Meningitis
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
- Bacterial meningitis is the infection of meninges by bacteria.
Empiric Therapy
Negative CSF Gram Stain
| Group | Etiology | Preferred Regimen | Alternative Regimen |
| Preterm—1 mo | Streptococcus agalactiae (49%) Escherichia coli (18%) misc. Gram-positive (10%) misc. Gram-negative (10%) Listeria (7%) |
Drug A PLUS Drug B |
Drug C PLUS Drug D |
| 1 mo—50 yrs | Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae† |
Cefotaxime 2 gm IV q4—6h OR Ceftriaxone 2 gm IV q12h PLUS Vancomycin 500—750 mg IV q6h‡ PLUS Dexamethasone |
|
| 123 | 123 | 123 | 123 |
† H. influenzae now very rare, listeria unlikely if young & immuno-competent (add ampicillin if suspect listeria: 2 gm IV q4h)
‡ Children’s dosage 15 mg/kg IV q6h (2x standard adult dose)