Template:Meningitis Antibiotics

Treatment guidelines based on van de Beek et al

Neonates (up to 1 month of age)

MRSA is uncommon in the neonate

• Ampicillin 75mg/kg IV q6hrs PLUS
• Cefotaxime 50mg/kg IV q6hrs OR Gentamicin 2.5mg/kg IV q8hrs
  • Per AAP, ceftazidime 50mg/kg IV (q12hr for babies < 8 days of age, q8hr for >7 days old) is a reasonable alternative to cefotaxime, offering virtually the same coverage for enteric bacilli and is FDA approved for all age groups
• If suspecting S. pneumoniae or MRSA, add Vancomycin
• Consider acyclovir for HSV

> 1 month to Adult

• Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
• Vancomycin 15-20 mg/kg IV BID daily
  • Vancomycin is for resistant Pneumococcus

> 50 yoa

• Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
• Vancomycin 15-20 mg/kg IV BID daily PLUS
• Ampicillin 2 g q4h (hourly if listeria suspected)

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