Meningitis

Diagnosis Common Pathogens Drug(s) of First Choice Alternative Drug(s) Comments Expected Duration

Meningitis
Community-onset

S. pneumoniae
Neisseria meningitidis

Listeria (especially in immuno-compromised, elderly patients,  or have alcohol use disorder)

Ceftriaxone 2g IV q12h
PLUS
Vancomycin

WITH OR WITHOUT*
Ampicillin 2g IV q4h

For severe PCN allergy:
Vancomycin
PLUS
Aztreonam 2g IV q6h

WITH OR WITHOUT*:
Trimethoprim/ Sulfamethoxazole (if Listeria) 15mg/kg/day (in divided doses)

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 should be added for adult patients >50 years of age or immunocompromised

ID consultation recommended

Meningitis
Post-neurosurgical or device associated

S. aureus
Coagulase negative
staphylococci
Gram negative rods

Cefepime 2g IV q8h
PLUS
Vancomycin

For severe PCN allergy:
Aztreonam 2g IV q8h
PLUS
Vancomycin

 

ID consultation recommended

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

2017 Infectious Diseases Society of America’s Clinical Practice Guidelines for Healthcare-Associated Ventriculitis and Meningitis. Clinical Infectious Diseases, Volume 64, Issue 6, 15 March 2017, Pages e34–e65, https://doi.org/10.1093/cid/ciw861