Template:Meningitis Antibiotics: Difference between revisions

(Created page with "'''Guidelines'''<ref>van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702</ref>: ====Age 18-50y==== #Ceftriaxone 2gm...")
 
(Add Nafcillin, Ampicillin/Sulbactam, and Meropenem AntibioticDose entries)
 
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'''Guidelines'''<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)<ref>van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702</ref>====
====Age 18-50y====
{{Neonatal meningitis antibiotics}}
#[[Ceftriaxone]] 2gm IV q12hr + [[vancomycin]] 15mg/kg q8-12hr
 
#(vancomycin is for resistant pneumococcus)
====> 1 month old<ref>van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702</ref>====
====Age >50y====
{{Pediatric meningitis antibiotics}}
#[[Ceftriaxone]] 2gm IV q12hr + [[vancomycin]] 15mg/kg q8-12hr + ampicillin 2gm IV q4h
 
#([[Ampicillin]] is for [[Listeria monocytogenes|Listeria]])
====Adult < 50 yr<ref>van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702</ref>====
====CSF leak with closed head trauma====
{{Young adult meningitis antibiotics}}
#[[Ceftriaxone]] 2gm IV q12hr + [[vancomycin]] 15mg/kg q8-12hr
 
====Penetrating head injury (or recent surgery)====  
====Adult > 50 yr and Immunocompromised<ref>van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702</ref>====
#(Ceftazidime 2gm IV q8hr or cefepime or meropenem) + vanco 25 milligrams/kg load
{{Elderly adult meningitis antibiotics}}
====Meningitis due to [[Sinusitis]]====
 
#[[Ceftriaxone]] + [[Metronidazole]]
====Post Procedural (or penetrating trauma)<ref>van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702</ref>====
*{{AntibioticDose|disease=Meningitis|drug=Vancomycin|dose=15-20mg/kg IV BID daily|context=Post-Procedural}} '''PLUS'''
*{{AntibioticDose|disease=Meningitis|drug=Cefepime|dose=2g (50mg/kg) IV q8 hours daily|context=Post-Procedural}} '''OR''' [[Ceftazidime]] 2g (50mg/kg) IV q8 hours daily '''OR''' [[Meropenem]] 2gm (40mg/kg) IV q8 hours daily
 
====[[Cryptococcosis]] Meningitis====
{{Crypto meningitis antibiotics}}
 
====Meningitis with severe PCN allergy====
====Meningitis with severe PCN allergy====
#chloramphenicol 1g IV q6h + [[vancomycin]] 15mg/kg q8-12hr
{{Meningitis peniccillin allergic antibiotics}}
 
====Meningitis with VP shunt====
*Coverage for skin contaminants ([[S. epidermis]], [[S. aureus]])
*[[Vancomycin]] plus [[ceftriaxone]] plus shunt removal
 
===[[Neisseria meningitidis]] Prophylaxis===
{{Neisseria meningitis prophylaxis}}
*{{AntibioticDose|drug=Ampicillin/Sulbactam|dose=400mg ampicillin/kg/day IM/IV divided q6 hours; First Dose: 100mg ampicillin/kg IM/IV x 1 (150mg Unasyn/kg IM/IV x 1); Max: 2000mg ampicillin (3000mg Unasyn) per DOSE|context=Meningitis|disease=Meningitis|population=Pediatric}}
*{{AntibioticDose|drug=Meropenem|dose=2g IV every 8 hours.|context=Meningitis|disease=Meningitis|population=Adult}}
*{{AntibioticDose|drug=Nafcillin|dose=100-200mg/kg/day IV divided q4-6h; Max: 12 g/day|context=Bacterial Meningitis|disease=Meningitis|population=Adult}}

Latest revision as of 10:53, 20 March 2026

Neonates (up to 1 month of age)[1]

MRSA is uncommon in the neonate

  • Ampicillin 75mg/kg IV q6hrs PLUS
  • Cefotaxime 50mg/kg IV q6hrs OR 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[2]
  • If suspecting S. pneumoniae or MRSA, add standard neonatal dosing
  • Consider acyclovir for HSV

> 1 month old[3]

Alternatives (e.g. penicillin/cephalosporin allergy):

Adult < 50 yr[4]

Adult > 50 yr and Immunocompromised[5]

Post Procedural (or penetrating trauma)[7]

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

Meningitis with severe PCN allergy

Meningitis with VP shunt

Neisseria meningitidis Prophylaxis

  • Ceftriaxone 250mg IM once
  • Ceftriaxone 125mg IM once (if <=15yr)
  • Ciprofloxacin 500mg PO once
  • Rifampin 600 mg PO BID x 2 days
  • Rifampin <1mo: 5mg/kg PO BID x 2 days; >=1mo: 10mg/kg PO BID x 2 days
  • Ampicillin/Sulbactam 400mg ampicillin/kg/day IM/IV divided q6 hours; First Dose: 100mg ampicillin/kg IM/IV x 1 (150mg Unasyn/kg IM/IV x 1); Max: 2000mg ampicillin (3000mg Unasyn) per DOSE
  • Meropenem 2g IV every 8 hours.
  • Nafcillin 100-200mg/kg/day IV divided q4-6h; Max: 12 g/day
  1. ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  2. ↑ https://www.aappublications.org/content/early/2015/02/25/aapnews.20150225-1
  3. ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  4. ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  5. ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
  6. ↑ [Guideline] Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008 Jul. 15(7):649-59.
  7. ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
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