Bacterial meningitis - Acute
Definition
Inflammation of the membranes surrounding the spinal cord and brain caused by bacterial infection and the host's protective response to it
Medical History
* Patient immunocompromised
* Infectious disease
* Head trauma
* Abscess of brain [Abscess of brain - Acute]
* Operation on nervous system
* Cerebrospinal fluid leak
* Sickle cell anemia [Sickle cell anemia - Acute]
* Ventriculoperitoneal shunt
* Provision of day care
* Crowded living space
* Implantation of cochlear prosthetic device
Findings
* Altered mental status
* Fever
* Nuchal rigidity
* Headache
* Seizure
* Coma
* Rash - Acute
* Nausea and vomiting - Acute
* Feeding poor
* Light intolerance
* Bulging fontanelle
* Kernig's sign
* Brudzinski's sign
* Tender mastoid
* Otitis media - Acute
* Facial sinus finding
* Respiratory distress
* Apnea
* Increased head circumference
* Optic disc edema
* Hypothermia - Acute
* Cranial nerve disorder
* Bradyarrhythmia - Acute
* Hypotension
* Jaundice
Tests
Suspected meningitis
* Blood culture: Blood cultures should be obtained in all cases of suspected bacterial meningitis, and blood specimens should collected before the start of antibiotic therapy unless it delays treatment .
Suspected bacterial meningitis
* Lumbar puncture: A lumbar puncture is performed urgently (unless prior CT is warranted) to measure opening cerebrospinal fluid (CSF) pressure and obtain CSF for analysis .
Suspected bacterial meningitis
* Cerebrospinal fluid examination: Cerebrospinal fluid findings consistent with bacterial meningitis include decreased glucose level, increased protein level and WBC count, and positive Gram stain and culture .
Suspected bacterial meningitis
* CSF gram stain method: Cerebrospinal fluid Gram stain is a useful method for the preliminary diagnosis of bacterial meningitis; however, a negative Gram stain does not rule out the disease .
Suspected bacterial meningitis
* Cerebrospinal fluid culture: Bacterial culture of the cerebrospinal fluid is critical in making the diagnosis of bacterial meningitis, identifying the causative organism, and selecting the appropriate antibiotic treatment regimen .
Suspected meningitis
* CT of head: A head CT prior to lumbar puncture (LP) is recommended if the clinical presentation suggests a mass lesion or another cause of increased intracranial pressure .
Initial laboratory evaluation of suspected meningitis
* Plasma random glucose measurement
* Complete blood count with white cell differential, automated
* Platelet count
* Electrolytes measurement, serum
Suspected and known disseminated intravascular coagulation (DIC)
* Disseminated intravascular coagulation screen: A panel of tests is more efficient and accurate than a single test in diagnosing disseminated intravascular coagulation (DIC) .
Suspected meningitis
* Latex agglutination test, cerebrospinal fluid: A positive latex agglutination test supports an organism-specific meningitis diagnosis. However, due to false results and no demonstrable impact on treatment decisions, it is not recommended routinely .
Suspected bacterial meningitis
* Procalcitonin measurement, serum: In suspected meningitis, elevated procalcitonin levels may suggest a bacterial etiology .
Suspected meningitis
* Microbial identification by nucleic acid probe, with amplification (PCR): Polymerase chain reaction appears useful for the rapid diagnosis of bacterial meningitis, but should still be considered an adjunct to culture of the causative organism .
Suspected bacterial meningitis
* Serum C reactive protein level: An elevated serum C-reactive protein (CRP) level may suggest bacterial meningitis in Gram stain-negative patients , but does not confirm the diagnosis. A normal CRP indicates nonbacterial meningitis, and is more reliable in this clinical situation .
Differential Diagnosis
* Bacterial meningitis, partially treated
* Aseptic meningitis
* Viral meningitis - Acute
* Subarachnoid hemorrhage
* Viral encephalitis - Acute
* Migraine - Acute
* Seizure
* Meningitis due to other organisms
* Diabetic ketoacidosis - Acute
* Hypoglycemia - Acute
* Blunt head trauma - Acute
* Systemic lupus erythematosus
* Abscess of brain - Acute
* Empyema - Acute
* Cerebral venous sinus thrombosis - Acute
* Pseudotumor cerebri - Acute
* Hepatic encephalopathy - Acute
* Chemical meningitis
* Malignant meningitis
* Aseptic meningitis due to drug
* Toxoplasmosis - Acute
* Reye's syndrome
* Disease due to West Nile virus - Acute
Treatment
Drug Therapy
Empiric antibiotic therapy for neonates less than 30 days of age with suspected or known meningitis
AMPICILLIN - CEFOTAXIME SODIUM
Pediatrics (neonates >2 kg, 0 to 7 days): Ampicillin 150 mg/kg/day in divided doses every 8 hours AND cefotaxime 100 to 150 mg/kg/day in divided doses every 8 to 12 hours; may be given IV or IM
Pediatrics (neonates >2 kg, 8 to 28 days): Ampicillin 200 mg/kg/day in divided doses every 6 to 8 hours AND cefotaxime 150 to 200 mg/kg/day in divided doses every 6 to 8 hours; may be given IV or IM
AMPICILLIN - GENTAMICIN SULFATE
Pediatrics (neonates >2 kg, 0 to 7 days): Ampicillin 150 mg/kg/day in divided doses every 8 hours AND gentamicin 5 mg/kg/day in divided doses every 12 hours; may be given IV or IM
Pediatrics (neonates >2kg, 8 to 28 days): Ampicillin 200 mg/kg/day in divided doses every 6 to 8 hours AND gentamicin 7.5 mg/kg/day in divided doses every 8 hours; may be given IV or IM
Empiric antibiotic therapy for children 1 month to 18 years of age with suspected or known bacterial meningitis
VANCOMYCIN HYDROCHLORIDE - CEFTRIAXONE SODIUM
Pediatrics (1 month to 18 years): Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND ceftriaxone 80 to 100 mg/kg/day IV in divided doses every 12 to 24 hours
VANCOMYCIN HYDROCHLORIDE - CEFOTAXIME SODIUM
Pediatrics (1 month to 18 years): Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND cefotaxime 225 to 300 mg/kg/day IV in divided doses every 6 to 8 hours
Empiric antibiotic therapy for adults 18 to 50 years old with suspected or known bacterial meningitis
VANCOMYCIN HYDROCHLORIDE - CEFTRIAXONE SODIUM
Adults (18 to 50 years): Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND ceftriaxone 4 g/day IV in divided doses every 12 to 24 hours
VANCOMYCIN HYDROCHLORIDE - CEFOTAXIME SODIUM
Adults (18 to 50 years): Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND cefotaxime 8 to 12 g/day IV in divided doses every 4 to 6 hours
Empiric antibiotic therapy for adults over 50 years old with suspected or known bacterial meningitis
VANCOMYCIN HYDROCHLORIDE - AMPICILLIN - CEFTRIAXONE SODIUM
Adults (>50 years): Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND ampicillin 12 g/day IV in divided doses every 4 hours AND ceftriaxone 4 g/day IV in divided doses every 12 to 24 hours
VANCOMYCIN HYDROCHLORIDE - AMPICILLIN - CEFOTAXIME SODIUM
Adults (>50 years): Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours AND ampicillin 12 g/day IV in divided doses every 4 hours AND cefotaxime 8 to 12 g/day IV in divided doses every 4 to 6 hours
Empiric antibiotic therapy for patients with a basilar skull fracture and suspected or known bacterial meningitis
VANCOMYCIN HYDROCHLORIDE - CEFTRIAXONE SODIUM
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND ceftriaxone 4 g/day IV in divided doses every 12 to 24 hours
Pediatrics: Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND ceftriaxone 80 to 100 mg/kg/day IV in divided doses every 12 to 24 hours
VANCOMYCIN HYDROCHLORIDE - CEFOTAXIME SODIUM
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND cefotaxime 8 to 12 g/day IV in divided doses every 4 to 6 hours
Pediatrics: Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND cefotaxime 225 to 300 mg/kg/day IV in divided doses every 6 to 8 hours
Empiric antibiotic therapy for patients with meningitis associated with penetrating head trauma, a CSF shunt, or recent neurosurgery
VANCOMYCIN HYDROCHLORIDE - CEFEPIME HYDROCHLORIDE
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND cefepime 6 g/day IV in divided doses every 8 hours
Pediatrics: Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND cefepime 150 mg/kg/day IV in divided doses every 8 hours
VANCOMYCIN HYDROCHLORIDE - CEFTAZIDIME
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND ceftazidime 6 g/day IV in divided doses every 8 hours
Pediatrics: Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND ceftazidime 150 mg/kg/day IV in divided doses every 8 hours
VANCOMYCIN HYDROCHLORIDE - MEROPENEM
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND meropenem 6 g/day IV in divided doses every 8 hours
Pediatrics: Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND meropenem 120 mg/kg/day IV in divided doses every 8 hours
Targeted therapy for adults with suspected pneumococcal meningitis
VANCOMYCIN HYDROCHLORIDE - CEFTRIAXONE SODIUM
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND ceftriaxone 4 g/day IV in divided doses every 12 to 24 hours for 10 to 14 days
VANCOMYCIN HYDROCHLORIDE - CEFOTAXIME SODIUM
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND cefotaxime 8 to 12 g/day IV in divided doses every 4 to 6 hours for 10 to 14 days
MOXIFLOXACIN HYDROCHLORIDE
Adults: 400 mg IV once daily for 10 to 14 days
MEROPENEM
Adults: 6 g/day IV in divided doses every 8 hours for 10 to 14 days
Targeted therapy for adults with suspected meningococcal meningitis
CEFTRIAXONE SODIUM
Adults: 4 g/day IV in divided doses every 12 to 24 hours for 7 days
CEFOTAXIME SODIUM
Adults: 8 to 12 g/day IV in divided doses every 4 to 6 hours for 7 days
PENICILLIN G POTASSIUM
Adults: 24 million units/day IV in divided doses every 4 hours for 7 days
AMPICILLIN
Adults: 12 g/day IV in divided doses every 4 hours for 7 days
CHLORAMPHENICOL
Adults: 4 to 6 g/day IV in divided doses every 6 hours for 7 days
MOXIFLOXACIN HYDROCHLORIDE
Adults: 400 mg IV once daily for 7 days
AZTREONAM
Adults: 6 to 8 g/day IV in divided doses every 6 to 8 hours for 7 days
Targeted therapy for adults with suspected Haemophilus meningitis
CEFTRIAXONE SODIUM
Adults: 4 g/day IV in divided doses every 12 to 24 hours for 7 days
CEFOTAXIME SODIUM
Adults: 8 to 12 g/day IV in divided doses every 4 to 6 hours for 7 days
CEFEPIME HYDROCHLORIDE
Adults: 6 g/day IV in divided doses every 8 hours for 7 days
MEROPENEM
Adults: 6 g/day IV in divided doses every 8 hours for 7 days
CHLORAMPHENICOL
Adults: 4 to 6 g/day IV in divided doses every 6 hours for 7 days
MOXIFLOXACIN HYDROCHLORIDE
Adults: 400 mg IV once daily for 7 days
Targeted therapy for adults with suspected Listeria meningitis
AMPICILLIN
Adults: 12 g/day IV in divided doses every 4 hours for at least 21 days
AMPICILLIN - GENTAMICIN SULFATE
Adults: Ampicillin 12 g/day IV in divided doses every 4 hours AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours for at least 21 days
PENICILLIN G POTASSIUM
Adults: 24 million units/day IV in divided doses every 4 hours for at least 21 days
PENICILLIN G POTASSIUM - GENTAMICIN SULFATE
Adults: Penicillin G 24 million units/day IV in divided doses every 4 hours AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours for at least 21 days
SULFAMETHOXAZOLE/TRIMETHOPRIM
Adults: 10 to 20 mg/kg/day (trimethoprim component) IV in divided doses every 6 to 12 hours for at least 21 days
MEROPENEM
Adults: 6 g/day IV in divided doses every 8 hours for at least 21 days
Targeted therapy for adults with suspected Escherichia coli meningitis
CEFTRIAXONE SODIUM
Adults: 4 g/day IV in divided doses every 12 to 24 hours for 21 days
CEFOTAXIME SODIUM
Adults: 8 to 12 g/day IV in divided doses every 4 to 6 hours for 21 days
CEFEPIME HYDROCHLORIDE
Adults: 6 g/day IV in divided doses every 8 hours for 21 days
MEROPENEM
Adults: 6 g/day IV in divided doses every 8 hours for 21 days
AZTREONAM
Adults: 6 to 8 g/day IV in divided doses every 6 to 8 hours for 21 days
MOXIFLOXACIN HYDROCHLORIDE
Adults: 400 mg IV once daily for 21 days
SULFAMETHOXAZOLE/TRIMETHOPRIM
Adults: 10 to 20 mg/kg/day (trimethoprim component) IV in divided doses every 6 to 12 hours for 21 days
Antibiotic therapy for penicillin-sensitive pneumococcal meningitis
PENICILLIN G POTASSIUM
Adults: 24 million units/day IV in divided doses every 4 hours for 10 to 14 days
Pediatrics: 0.3 million units/kg/day IV in divided doses every 4 to 6 hours for 10 to 14 days
AMPICILLIN
Adults: 12 g/day IV in divided doses every 4 hours for 10 to 14 days
Pediatrics: 300 mg/kg/day IV in divided doses every 6 hours for 10 to 14 days
CEFTRIAXONE SODIUM
Adults: 4 g/day IV in divided doses every 12 to 24 hours for 10 to 14 days
Pediatrics: 80 to 100 mg/kg/day IV in divided doses every 12 to 24 hours for 10 to 14 days
CEFOTAXIME SODIUM
Adults: 8 to 12 g/day IV in divided doses every 4 to 6 hours for 10 to 14 days
Pediatrics: 225 to 300 mg/kg/day IV in divided doses every 6 to 8 hours for 10 to 14 days
CHLORAMPHENICOL
Adults: 4 to 6 g/day IV in divided doses every 6 hours for 10 to 14 days
Pediatrics: 75 to 100 mg/kg/day IV in divided doses every 6 hours for 10 to 14 days
Antibiotic therapy for penicillin-resistant pneumococcal meningitis
VANCOMYCIN HYDROCHLORIDE - CEFTRIAXONE SODIUM
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND ceftriaxone 4 g/day IV in divided doses every 12 to 24 hours for 10 to 14 days
Pediatrics: Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND ceftriaxone 80 to 100 mg/kg/day IV in divided doses every 12 to 24 hours for 10 to 14 days
VANCOMYCIN HYDROCHLORIDE - CEFOTAXIME SODIUM
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND cefotaxime 8 to 12 g/day IV in divided doses every 4 to 6 hours for 10 to 14 days
Pediatrics: Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND cefotaxime 225 to 300 mg/kg/day IV in divided doses every 6 to 8 hours for 10 to 14 days
MOXIFLOXACIN HYDROCHLORIDE
Adults: 400 mg IV once daily for 10 to 14 days
Antibiotic therapy for penicillin-sensitive meningococcal meningitis
PENICILLIN G POTASSIUM
Adults: 24 million units/day IV in divided doses every 4 hours for 7 days
Pediatrics: 0.3 million units/kg/day IV in divided doses every 4 to 6 hours for 7 days
AMPICILLIN
Adults: 12 g/day IV in divided doses every 4 hours for 7 days
Pediatrics: 300 mg/kg/day IV in divided doses every 6 hours for 7 days
CEFTRIAXONE SODIUM
Adults: 4 g/day IV in divided doses every 12 to 24 hours for 7 days
Pediatrics: 80 to 100 mg/kg/day IV in divided doses every 12 to 24 hours for 7 days
CEFOTAXIME SODIUM
Adults: 8 to 12 g/day IV in divided doses every 4 to 6 hours for 7 days
Pediatrics: 225 to 300 mg/kg/day IV in divided doses every 6 to 8 hours for 7 days
CHLORAMPHENICOL
Adults: 4 to 6 g/day IV in divided doses every 6 hours for 7 days
Pediatrics: 75 to 100 mg/kg/day IV in divided doses every 6 hours for 7 days
Antibiotic therapy for penicillin-resistant meningococcal meningitis
CEFTRIAXONE SODIUM
Adults: 4 g/day IV in divided doses every 12 to 24 hours for 7 days
Pediatrics: 80 to 100 mg/kg/day IV in divided doses every 12 to 24 hours for 7 days
CEFOTAXIME SODIUM
Adults: 8 to 12 g/day IV in divided doses every 4 to 6 hours for 7 days
Pediatrics: 225 to 300 mg/kg/day IV in divided doses every 6 to 8 hours for 7 days
CHLORAMPHENICOL
Adults: 4 to 6 g/day IV in divided doses every 6 hours for 7 days
Pediatrics: 75 to 100 mg/kg/day IV in divided doses every 6 hours for 7 days
MOXIFLOXACIN HYDROCHLORIDE
Adults: 400 mg IV once daily for 7 days
MEROPENEM
Adults: 6 g/day IV in divided doses every 8 hours for 7 days
Pediatrics: 120 mg/kg/day IV in divided doses every 8 hours for 7 days
Primary prevention for contacts exposed to meningococcal meningitis
RIFAMPIN
Adults: 600 mg orally every 12 hours for 2 days
Pediatrics (?1 month): 10 mg/kg orally every 12 hours for 2 days
Pediatrics (<1 month): 5 mg/kg orally every 12 hours for 2 days
CEFTRIAXONE SODIUM
Adults (>12 years): 250 mg IM as single dose
Pediatrics (?12 years): 125 mg IM as single dose
CIPROFLOXACIN
Adults: 500 mg orally as single dose
Antibiotic therapy for Listeria meningitis
PENICILLIN G POTASSIUM
Adults: 24 million units/day IV in divided doses every 4 hours for at least 21 days
Pediatrics: 0.3 million units/kg/day IV in divided doses every 4 to 6 hours for at least 21 days
AMPICILLIN
Adults: 12 g/day IV in divided doses every 4 hours for at least 21 days
Pediatrics: 300 mg/kg/day IV in divided doses every 6 hours for at least 21 days
PENICILLIN G POTASSIUM - GENTAMICIN SULFATE
Adults: Penicillin G 24 million units/day IV in divided doses every 4 hours AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours for at least 21 days
Pediatrics: Penicillin G 0.3 million units/kg/day IV in divided doses every 4 to 6 hours AND gentamicin 7.5 mg/kg/day IV in divided doses every 8 hours for at least 21 days
AMPICILLIN - GENTAMICIN SULFATE
Adults: Ampicillin 12 g/day IV in divided doses every 4 hours AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours for at least 21 days
Pediatrics: Ampicillin 300 mg/kg/day IV in divided doses every 6 hours AND gentamicin 7.5 mg/kg/day IV in divided doses every 8 hours for at least 21 days
SULFAMETHOXAZOLE/TRIMETHOPRIM
Adults: 10 to 20 mg/kg/day (trimethoprim component) IV in divided doses every 6 to 12 hours for at least 21 days
Pediatrics: 10 to 20 mg/kg/day (trimethoprim component) IV in divided doses every 6 to 12 hours for at least 21 days
MEROPENEM
Adults: 6 g/day IV in divided doses every 8 hours for at least 21 days
Pediatrics: 120 mg/kg/day IV in divided doses every 8 hours for at least 21 days
Antibiotic therapy for Escherichia coli meningitis
CEFTRIAXONE SODIUM
Adults: 4 g/day IV in divided doses every 12 to 24 hours for 21 days
Pediatrics: 80 to 100 mg/kg/day IV in divided doses every 12 to 24 hours for 21 days
CEFOTAXIME SODIUM
Adults: 8 to 12 g/day IV in divided doses every 4 to 6 hours for 21 days
Pediatrics: 225 to 300 mg/kg/day IV in divided doses every 6 to 8 hours for 21 days
AZTREONAM
Adults: 6 to 8 g/day IV divided every 6 to 8 hours for 21 days
MOXIFLOXACIN HYDROCHLORIDE
Adults: 400 mg IV once daily for 21 days
MEROPENEM
Adults: 6 g/day IV in divided doses every 8 hours for 21 days
Pediatrics: 120 mg/kg/day IV in divided doses every 8 hours for 21 days
SULFAMETHOXAZOLE/TRIMETHOPRIM
Adults: 10 to 20 mg/kg/day (trimethoprim component) IV in divided doses every 6 to 12 hours for 21 days
Pediatrics: 10 to 20 mg/kg/day (trimethoprim component) IV in divided doses every 6 to 12 hours for 21 days
AMPICILLIN
Adults: 12 g/day IV in divided doses every 4 hours for 21 days
Pediatrics: 300 mg/kg/day IV in divided doses every 6 hours for 21 days
Antibiotic therapy for Pseudomonas meningitis
CEFEPIME HYDROCHLORIDE
Adults: 6 g/day IV in divided doses every 8 hours
Pediatrics: 150 mg/kg/day IV in divided doses every 8 hours
CEFTAZIDIME
Adults: 6 g/day IV in divided doses every 8 hours
Pediatrics: 150 mg/kg/day IV in divided doses every 8 hours
CEFEPIME HYDROCHLORIDE - GENTAMICIN SULFATE
Adults: Cefepime 6 g/day IV in divided doses every 8 hours AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours
Pediatrics: Cefepime 150 mg/kg/day IV in divided doses every 8 hours AND gentamicin 7.5 mg/kg/day IV in divided doses every 8 hours
CEFTAZIDIME - GENTAMICIN SULFATE
Adults: Ceftazidime 6 g/day IV in divided doses every 8 hours AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours
Pediatrics: Ceftazidime 150 mg/kg/day IV in divided doses every 8 hours AND gentamicin 7.5 mg/kg/day IV in divided doses every 8 hours
AZTREONAM
Adults: 6 to 8 g/day IV in divided doses every 6 to 8 hours
CIPROFLOXACIN
Adults: 800 to 1200 mg/day IV in divided doses every 8 to 12 hours
MEROPENEM
Adults: 6 g/day IV in divided doses every 8 hours
Pediatrics: 120 mg/kg/day IV in divided doses every 8 hours
AZTREONAM - GENTAMICIN SULFATE
Adults: Aztreonam 6 to 8 g/day IV in divided doses every 6 to 8 hours AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours
CIPROFLOXACIN - GENTAMICIN SULFATE
Adults: Ciprofloxacin 800 to 1200 mg/day IV in divided doses every 8 to 12 hours AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours
MEROPENEM
Adults: Meropenem 6 g/day IV in divided doses every 8 hours AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours
Pediatrics: Meropenem 120 mg/kg/day IV in divided doses every 8 hours AND gentamicin 7.5 mg/kg/day IV in divided doses every 8 hours
Antibiotic therapy for beta-lactamase negative Haemophilus meningitis
AMPICILLIN
Adults: 12 g/day IV in divided doses every 4 hours for 7 days
Pediatrics: 300 mg/kg/day IV in divided doses every 6 hours for 7 days
CEFTRIAXONE SODIUM
Adults: 4 g/day IV in divided doses every 12 to 24 hours for 7 days
Pediatrics: 80 to 100 mg/kg/day IV in divided doses every 12 to 24 hours for 7 days
CEFOTAXIME SODIUM
Adults: 8 to 12 g/day IV in divided doses every 4 to 6 hours for 7 days
Pediatrics: 225 to 300 mg/kg/day IV in divided doses every 6 to 8 hours for 7 days
CEFEPIME HYDROCHLORIDE
Adults: 6 g/day IV in divided doses every 8 hours for 7 days
Pediatrics: 150 mg/kg/day IV in divided doses every 8 hours for 7 days
CHLORAMPHENICOL
Adults: 4 to 6 g/day IV in divided doses every 6 hours for 7 days
Pediatrics: 75 to 100 mg/kg/day IV in divided doses every 6 hours for 7 days
MOXIFLOXACIN HYDROCHLORIDE
Adults: 400 mg IV once daily for 7 days
Antibiotic therapy for beta-lactamase positive Haemophilus meningitis
CEFTRIAXONE SODIUM
Adults: 4 g/day IV in divided doses every 12 to 24 hours for 7 days
Pediatrics: 80 to 100 mg/kg/day IV in divided doses every 12 to 24 hours for 7 days
CEFOTAXIME SODIUM
Adults: 8 to 12 g/day IV in divided doses every 4 to 6 hours for 7 days
Pediatrics: 225 to 300 mg/kg/day IV in divided doses every 6 to 8 hours for 7 days
CEFEPIME HYDROCHLORIDE
Adults: 6 g/day IV in divided doses every 8 hours for 7 days
Pediatrics: 150 mg/kg/day IV in divided doses every 8 hours for 7 days
CHLORAMPHENICOL
Adults: 4 to 6 g/day IV in divided doses every 6 hours for 7 days
Pediatrics: 75 to 100 mg/kg/day IV in divided doses every 6 hours for 7 days
MOXIFLOXACIN HYDROCHLORIDE
Adults: 400 mg IV once daily for 7 days
Primary prevention for contacts exposed to Haemophilus meningitis
RIFAMPIN
Adults: 600 mg orally once daily for 4 days
Pediatrics (>1 month): 20 mg/kg orally (maximum 600 mg) once daily for 4 days
Antibiotic therapy for methicillin-sensitive Staphylococcus aureus meningitis
NAFCILLIN SODIUM
Adults: 9 to 12 g/day IV in divided doses every 4 hours
Pediatrics: 200 mg/kg/day IV or IM in divided doses every 6 hours
OXACILLIN SODIUM
Adults: 9 to 12 g/day IV in divided doses every 4 hours
Pediatrics: 200 mg/kg/day IV or IM in divided doses every 6 hours
VANCOMYCIN HYDROCHLORIDE
Adults: 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL
Pediatrics: 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL
MEROPENEM
Adults: 6 g/day IV in divided doses every 8 hours
Pediatrics: 120 mg/kg/day IV in divided doses every 8 hours
Antibiotic therapy for methicillin-resistant Staphylococcus aureus meningitis
VANCOMYCIN HYDROCHLORIDE
Adults: 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL
Pediatrics: 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL
VANCOMYCIN HYDROCHLORIDE - RIFAMPIN
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND rifampin 600 mg IV once daily
Pediatrics: Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND rifampin 10 to 20 mg/kg/day IV in divided doses every 12 to 24 hours; maximum 600 mg/day
SULFAMETHOXAZOLE/TRIMETHOPRIM
Adults: 10 to 20 mg/kg/day (trimethoprim component) IV in divided doses every 6 to 12 hours
Pediatrics: 10 to 20 mg/kg/day (trimethoprim component) IV in divided doses every 6 to 12 hours
LINEZOLID
Adults: 600 mg IV every 12 hours
Pediatrics: 30 mg/kg/day intravenously in 2 or 3 divided doses
Antibiotic therapy for penicillin-sensitive Enterococcus meningitis
AMPICILLIN - GENTAMICIN SULFATE
Adults: Ampicillin 12 g/day IV in divided doses every 4 hours AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours
Pediatrics: Ampicillin 300 mg/kg/day IV in divided doses every 6 hours AND gentamicin 7.5 mg/kg/day IV in divided doses every 8 hours
Antibiotic therapy for penicillin-resistant Enterococcus meningitis
VANCOMYCIN HYDROCHLORIDE - GENTAMICIN SULFATE
Adults: Vancomycin 30 to 45 mg/kg/day IV in divided doses every 8 to 12 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND gentamicin 5 mg/kg/day IV in divided doses every 8 hours
Pediatrics: Vancomycin 60 mg/kg/day IV in divided doses every 6 hours, maintaining a serum trough level of 15 to 20 mcg/mL, AND gentamicin 7.5 mg/kg/day IV in divided doses every 8 hours
Antibiotic therapy for vancomycin- and penicillin-resistant Enterococcus meningitis
LINEZOLID
Adults (>12 years): 600 mg IV every 12 hours
Pediatrics (1 month to 12 years): 10 mg/kg IV every 8 hours
Adjunctive treatment for suspected or known bacterial meningitis
DEXAMETHASONE
Adults: 0.15 mg/kg IV every 6 hours for 2 to 4 days; administer 10 to 20 minutes before or concurrently with first antibiotic dose; do not administer if antibiotics have already been given
Pediatrics (6 weeks to 18 years): 0.15 mg/kg IV every 6 hours for 2 to 4 days; administer 10 to 20 minutes before or concurrently with first antibiotic dose; do not administer if antibiotics have already been given
Fever
ACETAMINOPHEN
Adults: 650 to 1000 mg orally every 4 to 6 hours as needed; maximum 4 g/day
Pediatrics: 10 to 15 mg/kg orally or rectally every 4 to 6 hours as needed; maximum 5 doses or 4 g/day
Neonates: 10 to 15 mg/kg orally or rectally every 6 to 8 hours as needed
ASPIRIN
Adults: 650 to 1000 mg orally every 4 hours as needed; maximum 4 g/day
IBUPROFEN
Adults: 200 to 800 mg orally every 6 to 8 hours as needed; maximum 3.2 g/day
Pediatrics: 5 to 10 mg/kg orally every 6 to 8 hours as needed; maximum, lesser of 40 mg/kg/day or 2.4 g/day
Seizures
DIAZEPAM
LORAZEPAM
FOSPHENYTOIN SODIUM
PHENOBARBITAL SODIUM
Procedural Therapy
Suspected or known bacterial meningitis
* Isolation of infected patient: Droplet precautions are recommended for patients with Haemophilus influenzae or Neisseria meningitidis meningitis for the first 24 hours after therapy is initiated .
Respiratory distress
* Airway management: Airway management must assume the first priority in the management of any seriously ill or injured patient .
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