Sandbox/v20

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Classification Viral Meningitis Bacterial Meningitis Fungal Meningitis
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Diagnosis
Treatment

Enterococcal Strains Susceptible to Penicillin, Gentamicin, and Vancomycin

Enterococcus Susceptible to Penicillin, Gentamicin, and Vancomycin Preferred Regimen (Adult) ▸ Ampicillin 2 g IV q4h x 4—6 weeks OR ▸ Penicillin G potassium 3—5 million U/day IV q4h x 4—6 weeks PLUS ▸ Gentamicin 1 mg/kg IV q8h x 4—6 weeks Preferred Regimen (Pediatric) ▸ Ampicillin 2 g IV q4h x 4—6 weeks OR ▸ Penicillin G potassium 3—5 million U/day IV q4h x 4—6 weeks PLUS ▸ Gentamicin 1 mg/kg IV q8h x 4—6 weeks Alternative Regimen (Adult)† ▸ Vancomycin 15 mg/kg IV q12h x 6 weeks PLUS ▸ Gentamicin 1 mg/kg IV q8h x 6 weeks Alternative Regimen (Pediatric)† ▸ Vancomycin 15 mg/kg IV q12h x 6 weeks PLUS ▸ Gentamicin 1 mg/kg IV q8h x 6 weeks

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.

Adapted from Advances in treatment of bacterial meningitis. Lancet. 2012;395(9854):1693-702.