Template:Meningitis Antibiotics: Difference between revisions
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'' | ''Treatment guidelines based on van de Beek et al''<ref>van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702</ref> | ||
===Neonates (up to 1 month of age)=== | ===Neonates (up to 1 month of age)=== | ||
''MRSA is uncommon in the neonate | ''MRSA is uncommon in the neonate | ||
*[[Ampicillin]] 50mg/kg IV q6hrs PLUS | *[[Ampicillin]] 50mg/kg IV q6hrs '''PLUS''' | ||
*[[Cefotaxime]] 50mg/kg IV q6hrs '''OR''' [[Gentamicin]] 2.5mg/kg IV q8hrs | |||
*If suspecting [[S. pneumoniae]] or [[MRSA]], add [[Vancomycin]] | |||
*If suspecting [[S. pneumoniae]] or [[MRSA]], add [[ | |||
===> 1 month to Adult=== | ===> 1 month to Adult=== | ||
*[[Vancomycin]] 15-20 mg/kg IV BID daily PLUS | *[[Vancomycin]] 15-20 mg/kg IV BID daily '''PLUS''' | ||
*[[Ceftriaxone]] 2gm (50mg/kg) IV BID daily | |||
'''[[Vancomycin]] is for resistant [Pneumococcus]])''' | '''[[Vancomycin]] is for resistant [Pneumococcus]])''' | ||
===Post Procedural (or penetrating trauma)=== | ===Post Procedural (or penetrating trauma)=== | ||
*[[Vancomycin]] 15-20mg/kg IV BID daily PLUS | *[[Vancomycin]] 15-20mg/kg IV BID daily '''PLUS''' | ||
**[[Cefepime]] 2g (50mg/kg) IV q8 hours daily OR | **[[Cefepime]] 2g (50mg/kg) IV q8 hours daily '''OR''' [[Ceftazidime]] 2g (50mg/kg) IV q8 hours daily '''OR''' [[Meropenem]] 2gm (40mg/kg) IV q8 hours daily | ||
===[[Cryptococcosis]] Meningitis=== | ===[[Cryptococcosis]] Meningitis=== | ||
'''Options''' | '''Options''' | ||
* | *Amphotericin B 1mg/kg IV once daily '''AND''' Flucytosine 25mg/kg PO q6hrs daily | ||
* | *Amphotericin B 5mg/kg IV once daily '''AND''' Flucytosine 25mg/kg PO q6hrs daily | ||
===[[Neisseria meningitidis]] Prophylaxis=== | ===[[Neisseria meningitidis]] Prophylaxis=== | ||
*[[Ceftriaxone]] 250mg IM once (if less than | *[[Ceftriaxone]] 250mg IM once (if less than 15yr then 125mg IM) | ||
*[[Ciprofloxacin]] 500mg PO once | *[[Ciprofloxacin]] 500mg PO once | ||
*[[Rifampin]] 600 mg PO BID x 2 days | *[[Rifampin]] 600 mg PO BID x 2 days | ||
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===Age >50y=== | ===Age >50y=== | ||
*[[Ceftriaxone]] 2gm IV q12hr + [[ | *[[Ceftriaxone]] 2gm IV q12hr + [[Vancomycin]] 15mg/kg q8-12hr + [[Ampicillin]] 2gm IV q4h | ||
Revision as of 00:37, 23 April 2015
Treatment guidelines based on van de Beek et al[1]
Neonates (up to 1 month of age)
MRSA is uncommon in the neonate
- Ampicillin 50mg/kg IV q6hrs PLUS
- Cefotaxime 50mg/kg IV q6hrs OR Gentamicin 2.5mg/kg IV q8hrs
- If suspecting S. pneumoniae or MRSA, add Vancomycin
> 1 month to Adult
- Vancomycin 15-20 mg/kg IV BID daily PLUS
- Ceftriaxone 2gm (50mg/kg) IV BID daily
Vancomycin is for resistant [Pneumococcus]])
Post Procedural (or penetrating trauma)
- Vancomycin 15-20mg/kg IV BID daily PLUS
- Cefepime 2g (50mg/kg) IV q8 hours daily OR Ceftazidime 2g (50mg/kg) IV q8 hours daily OR Meropenem 2gm (40mg/kg) IV q8 hours daily
Cryptococcosis Meningitis
Options
- Amphotericin B 1mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
- Amphotericin B 5mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
Neisseria meningitidis Prophylaxis
- Ceftriaxone 250mg IM once (if less than 15yr then 125mg IM)
- Ciprofloxacin 500mg PO once
- Rifampin 600 mg PO BID x 2 days
- if < 1 month old then 5mg/kg PO BID x 2 days
- if ≥ 1 month old then 10mg/kg (max at 600mg) PO BID x 2 days
Meningitis with severe PCN allergy
- Chloramphenicol 1g IV q6h + Vancomycin 15mg/kg q8-12hr
Age >50y
- Ceftriaxone 2gm IV q12hr + Vancomycin 15mg/kg q8-12hr + Ampicillin 2gm IV q4h
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702