Meningitis medical therapy

Meningitis Main Page
Patient Information
Overview
Causes
Classification Viral Meningitis Bacterial Meningitis Fungal Meningitis
Differential Diagnosis
Diagnosis
Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]

Medical Therapy

Empiric Treatment

• Do not wait for the results of the CT scan and the lumbar puncture; empiric treatment should be started as soon as possible.
• Blood cultures should be drawn before starting the antibiotic therapy, and then the antibiotic treatment should be changed once the blood culture results are out.
• Empiric antibiotic treatment should be started within 30 minutes after the patient presentation.
• In case of high suspicion of pneumococcal meningitis in adult patients, 0.15 mg/kg IV Q6H dexomethasone should be administered for 2 to 4 days.
  • The first dose of dexomethasone is given along with or 20 minutes prior to starting the antibiotics treatment.

Shown below is a table summarizing the preferred and alternative empiric treatment for meningitis.

Characteristics of the Patient	Possible Pathogens	Preferred Treatment	Duration of Treatment	Alternative Treatment
Immunocompentent patient Age<50	Streptococcus pneumonia, Nisseria meningitis, Hemophilus influenzae	Vancomycin Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Ceftriaxone 2 g IV Q12H	Stop or adjust treatment choice and duration when the results of the lumbar puncture are out	In case of penicillin allergy: Chloramphenicol + Vancomycin
Immunocompentent patient Age>50	Streptococcus pneumonia, Listeria, Nisseria meningitis, Group B streptococci, Hemophilus influenzae	Vancomycin Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Ceftriaxone 2 g IV Q12H + Ampicillin 2 g IV Q4H	Stop or adjust treatment choice and duration when the results of the lumbar puncture are out	In case of penicillin allergy: Chloramphenicol + Vancomycin + TMP/SMX
Immunocompromised patient	Streptococcus pneumonia, Nisseria meningitis, Hemophilus influenzae, Listeria, (Gram-negatives)	Vancomycin Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Cefepime 2 g IV Q8H + Ampicillin 2 g IV Q4H	Stop or adjust treatment choice and duration when the results of the lumbar puncture are out	In case of penicillin allergy: Vancomycin + TMP/SMX + Ciprofloxacin
Patient with history of penetrating head trauma or neurosurgery	Streptococcus pneumonia (if CSF leak), Hemophilus influenzae, Staphylococci, (Gram-negatives)	Vancomycin Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Cefepime 2 g IV Q8H	Stop or adjust treatment choice and duration when the results of the lumbar puncture are out	In case of penicillin allergy: Vancomycin + Ciprofloxacin
Shunt infection	Streptococcus aureus, Coagulase negative staphylococci, Gram-negatives (rare)	Vancomycin Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Cefepime 2 g IV Q8H	Stop or adjust treatment choice and duration when the results of the lumbar puncture are out	In case of penicillin allergy: Vancomycin + Ciprofloxacin

Pathogen Specific Treatment

Shown below is a table summarizing the treatment of meningitis depending on the specific pathogen.

References

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