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{{Meningitis}}


{{CMG}}; {{AE}} {{CZ}}, {{SS}}


==Empiric Therapy==
{|style="width:10%;" border=2
 
| {{Sandbox/v31}}
<BIG><BIG>'''Community-Acquired Meningitis'''</BIG></BIG>
<div class="mw-customtoggle-table01" style="width: 300px; background: #F8F8FF; border: 2px solid #696969"> ▸&nbsp;&nbsp;&nbsp;<font color="#1f4099">'''Newborn, Age <1 Week'''</font></div>
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table01"
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;"
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Newborn, Age <1 Week}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 100—150 mg/kg/day IV q8—12h'''''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q12h'''''
|}
|}
<div class="mw-customtoggle-table02" style="width: 300px; background: #F8F8FF; border: 2px solid #696969"> ▸&nbsp;&nbsp;&nbsp;<font color="#1f4099">'''Newborn, Age 1—4 Weeks'''</font></div>
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table02"
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;"
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Newborn, Age 1—4 Weeks}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 150—200 mg/kg/day IV q6—8h'''''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q8h''''' <BR> OR <BR> ▸'''''[[Tobramycin]]2.5 mg/kg IV q8h''''' <BR> OR <BR> ▸ '''''[[Amikacin]] 10 mg/kg IV q8h'''''
|}
|}
<div class="mw-customtoggle-table03" style="width: 300px; background: #F8F8FF; border: 2px solid #696969"> ▸&nbsp;&nbsp;&nbsp;<font color="#1f4099">'''Infant & Children'''</font></div>
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table03"
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;"
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Infant & Children}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <BR> to achieve serum trough concentrations of 15–20 μg/mL
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 225—300 mg/kg/day IV q6–8h''''' <BR>''OR''<BR>▸'''''[[Ceftriaxone]] 80—100 mg/kg/day IV q12–24h'''''
|-
|}
|}
<div class="mw-customtoggle-table04" style="width: 300px; background: #F8F8FF; border: 2px solid #696969"> ▸&nbsp;&nbsp;&nbsp;<font color="#1f4099">'''Adult, Age <50 Years'''</font></div>
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table04"
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;"
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult, Age <50 Years}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h''''' <BR> to achieve serum trough concentrations of 15–20 μg/mL
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| <SMALL><sup>†</sup> Add '''''[[Ampicillin]] 2 g IV q4h''''' ('''''50 mg/kg IV q6h''''' for children) if meningitis caused by ''[[Listeria monocytogenes]]'' is also suspected.</SMALL>
 
|-
|}
|}
<div class="mw-customtoggle-table05" style="width: 300px; background: #F8F8FF; border: 2px solid #696969"> ▸&nbsp;&nbsp;&nbsp;<font color="#1f4099">'''Adult, Age >50 Years'''</font></div>
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table05"
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;"
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult, Age >50 Years}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
|}
|}
<div class="mw-customtoggle-table06" style="width: 300px; background: #F8F8FF; border: 2px solid #696969"> ▸&nbsp;&nbsp;&nbsp;<font color="#1f4099">'''Immunocompromised'''</font></div>
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table06"
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;"
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Immunocompromised}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h''''' <BR> ''OR'' <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
|}
|}
<div class="mw-customtoggle-table07" style="width: 300px; background: #F8F8FF; border: 2px solid #696969"> ▸&nbsp;&nbsp;&nbsp;<font color="#1f4099">'''Recurrent'''</font></div>
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table07"
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;"
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Recurrent}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]]  8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g IV q12h'''''
|}
|}
|}
<div class="mw-collapsible mw-collapsed">
=====Healthcare-Associated Meningitis=====
<div class="mw-collapsible-content">
{|
|-
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:32em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Basilar Skull Fracture}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]]  8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR> ▸'''''[[Ceftriaxone]] 2 g IV q12h'''''<BR><BR><BR>
|}
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:32em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Head Trauma; Post-Neurosurgery}}''
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h'''''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]]  2 g IV q8 h'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h'''''
|}
|}
<SMALL>Adapted from ''Advances in treatment of bacterial meningitis. Lancet. 2012;380(9854):1693-702.''</SMALL><ref name="van de Beek-2012">{{Cite journal  | last1 = van de Beek | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = Thwaites | first3 = GE. | last4 = Tunkel | first4 = AR. | title = Advances in treatment of bacterial meningitis. | journal = Lancet | volume = 380 | issue = 9854 | pages = 1693-702 | month = Nov | year = 2012 | doi = 10.1016/S0140-6736(12)61186-6 | PMID = 23141618 }}</ref>
</div></div>
==References==
{{reflist|2}}
[[Category:Needs overview]]
[[Category:Primary care]]
[[Category:Disease]]
[[Category:Infectious disease]]
[[Category:Neurology]]
[[Category:Emergency medicine]]
[[Category:Diseases involving the fasciae]]
[[Category:Inflammations]]
[[Category:Neurological disorders]]
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{{WikiDoc Sources}}

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