Hospitalized Adults: Central Nervous System Infections: Meningitis

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Doses provided in this table are for patients with normal renal and hepatic function. Click on drug link to go to dosing guidelines.  Some antimicrobials are restricted (ID-R).  Click on link for guidelines on obtaining authorization.

Diagnosis

Common Pathogens

Drug(s) of First Choice

Alternative Drug(s)

Comments

Meningitis

Community-onset

S. pneumoniae

Neisseria meningitidis

Listeria (especially in immuno-compromised, elderly patients, and alcoholics)

Ceftriaxone

2 g IV q12h

PLUS

Vancomycin

WITH OR WITHOUT* one of:

TMP/SMX 15 mg/kg/day (in divided doses)

OR

Ampicillin 2 g IV q4h 

For severe PCN allergy:

Vancomycin

PLUS

AztreonamID-R: SFGH 2 g IV q6h-q8h

WITH OR WITHOUT*:

TMP/SMX (if Listeria) 15 mg/kg/day (in divided doses) 

ID consultation recommended.

 

Therapy should be guided by Gram stain.

 

If bacterial meningitis suspected, dexamethasone 10 mg PO/IV q6h x 4 days given before or with initial dose of antibiotics.

 

*Coverage for Listeria with TMP/SMX or ampicillin should be added for patients who are <2 or >50 years of age or immunocompromised.

Meningitis

Post-neurosurgical or device associated

S. aureus

Coagulase negative

Staphylococci

Gram negative rods

CefepimeID-R: SFGH VASF 2 g IV q8h

PLUS

Vancomycin 

For severe PCN allergy:

AztreonamID-R: SFGH 2 g IV q6h-q8h

PLUS

Vancomycin

ID consultation recommended.

References:

Tunkel AR, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004 Nov 1;39(9):1267-84.