Meningitis medical therapy: Difference between revisions
Jump to navigation
Jump to search
Gerald Chi (talk | contribs) m (Blanked the page) |
Gerald Chi (talk | contribs) mNo edit summary |
||
Line 1: | Line 1: | ||
__NOEDITSECTION____NOTOC__ | |||
{{Meningitis}} | |||
{{CMG}}; {{AE}} {{CZ}}, {{SS}} | |||
==Principles of Therapy for Bacterial Meningitis== | |||
====Overview==== | |||
* Acute bacterial meningitis is a medical emergency; commence empiric treatment after obtaining blood and/or [[cerebrospinal fluid|cerebrospinal fluid (CSF)]] cultures if the possibility of bacterial meningitis becomes evident. Once a bacterial etiology has been identified on a [[CSF]] [[Gram stain]], treatment regimen should be optimized accordingly. Further modifications may be required after the culture and/or ''in vitro'' susceptibility results are available. | |||
* Neuroimaging (such as [[CT scan]] and [[MRI]]) or [[lumbar puncture]] must not delay antimicrobial therapy. | |||
====Factors Determining Antimicrobial Activity==== | |||
* Factors determine the acitivity of antimicrobial agents include [[pharmacodynamics]], [[pharmacokinetics]], penetration into the CSF, and [[bactericidal]] activity within the CSF.<ref name="Andes-1999">{{Cite journal | last1 = Andes | first1 = DR. | last2 = Craig | first2 = WA. | title = Pharmacokinetics and pharmacodynamics of antibiotics in meningitis. | journal = Infect Dis Clin North Am | volume = 13 | issue = 3 | pages = 595-618 | month = Sep | year = 1999 | doi = | PMID = 10470557 }}</ref> | |||
* [[Beta-lactam]]s, [[aminoglycoside]]s, [[glycopeptide]]s, [[linezolid]], and [[daptomycin]] are considered to have poor penetration into the CSF, while [[fluoroquinolone]]s, [[chloramphenicol]], [[aztreonam]], and [[tigecycline]] generally achieve [[MIC|minimum inhibitory concentration (MIC)]] in the CSF at standard dosage.<ref name="Nau-2010">{{Cite journal | last1 = Nau | first1 = R. | last2 = Sörgel | first2 = F. | last3 = Eiffert | first3 = H. | title = Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. | journal = Clin Microbiol Rev | volume = 23 | issue = 4 | pages = 858-83 | month = Oct | year = 2010 | doi = 10.1128/CMR.00007-10 | PMID = 20930076 }}</ref> | |||
* [[Aminoglycoside]]s and [[fluoroquinolone]]s express a concentration-dependent manner of bactericidal activity; [[beta-lactam]]s typically follow a a time-dependent antimicrobial pattern (i.e., the activity is dependent on the time that CSF concentration exceeds [[MIC]] as a proportion of the dosing interval). | |||
* Penetration into the CSF is less prominent for drugs with a high [[molecular weight]], high protein-binding ability, low lipid solubility, and drugs that are subject to [[active transport]] in the [[choroid plexus]] such as [[penicillin]]s and [[cephalosporin]]s. Toxicity due to dose escalation may limit the usage the [[aminoglycoside]]s, [[glycopeptide]]s, and [[polymyxin]]s, thus [[intrathecal]] or [[intraventricular]] administration might be occasionally required (see table below). | |||
{| style="border: 2px solid #696969;" align="center" | |||
|+ <SMALL>''Recommended Doses of Antimicrobial Agents via the Intraventricular Route.''<ref name="van de Beek-2010">{{Cite journal | last1 = van de Beek | first1 = D. | last2 = Drake | first2 = JM. | last3 = Tunkel | first3 = AR. | title = Nosocomial bacterial meningitis. | journal = N Engl J Med | volume = 362 | issue = 2 | pages = 146-54 | month = Jan | year = 2010 | doi = 10.1056/NEJMra0804573 | PMID = 20071704 }}</ref><ref name="Rodríguez Guardado-2008">{{Cite journal | last1 = Rodríguez Guardado | first1 = A. | last2 = Blanco | first2 = A. | last3 = Asensi | first3 = V. | last4 = Pérez | first4 = F. | last5 = Rial | first5 = JC. | last6 = Pintado | first6 = V. | last7 = Bustillo | first7 = E. | last8 = Lantero | first8 = M. | last9 = Tenza | first9 = E. | title = Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments. | journal = J Antimicrob Chemother | volume = 61 | issue = 4 | pages = 908-13 | month = Apr | year = 2008 | doi = 10.1093/jac/dkn018 | PMID = 18281693 }}</ref><ref name="Cruciani-1992">{{Cite journal | last1 = Cruciani | first1 = M. | last2 = Navarra | first2 = A. | last3 = Di Perri | first3 = G. | last4 = Andreoni | first4 = M. | last5 = Danzi | first5 = MC. | last6 = Concia | first6 = E. | last7 = Bassetti | first7 = D. | title = Evaluation of intraventricular teicoplanin for the treatment of neurosurgical shunt infections. | journal = Clin Infect Dis | volume = 15 | issue = 2 | pages = 285-9 | month = Aug | year = 1992 | doi = | PMID = 1387805 }}</ref></SMALL> | |||
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px"| '''Antimicrobial Agent''' || style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px" | '''Daily Intraventricular Dose''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Vancomycin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—20 mg''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Gentamicin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''4—8 mg''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Tobramycin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—20 mg''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Amikacin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—50 mg''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Polymyxin B]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5 mg''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Colistin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''10 mg''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Quinupristin dalfopristin|Quinupristin/Dalfopristin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''2—5 mg''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Teicoplanin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—40 mg''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Amphotericin B]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''0.1—0.5 mg/day''''' | |||
|- | |||
|} | |||
====Duration of Antimicrobial Therapy==== | |||
* The duration of therapy in patients with bacterial meningitis has not been well-supported by evidence-based data. | |||
* The IDSA Practice Guideline provides recommendations on the duration of antimicrobial agents based on microorganisms (see table below). However, the duration of antimicrobial therapy should be individualized in accordance with patient's clinical response. | |||
* Maximum [[parenteral]] dosage should be maintained throughout the recommended duration of therapy to ensure adequate bactericidal concentrations are attained since antimicrobial entry attenuates as [[meninges|meningeal]] inflammation subsides, especially when [[dexamethasone]] is co-administered. | |||
{| style="border: 2px solid #696969;" align="center" | |||
|+ <SMALL>''Recommended Duration of Antimicrobial Therapy Based on Isolated Pathogen.''<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref></SMALL> | |||
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px"| '''''Microorganism''''' || style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px" | '''Duration of Therapy''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Neisseria meningitidis]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''7 days''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Haemophilus influenzae]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''7 days''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Streptococcus pneumoniae]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''10—14 days''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Streptococcus agalactiae]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''14—21 days''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Gram-negative bacteria|Aerobic Gram-negative bacilli]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''21 days''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left | ▸ '''''[[Listeria monocytogenes]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''≥21 days''''' | |||
|- | |||
|} | |||
====Adjunctive Dexamethasone Therapy==== | |||
* Evidences for beneficial effects of [[dexamethasone]] are variable. In some studies, adjunctive use of dexamethasone for bacterial meningitis in selected groups are associated with an improved survival or prognosis.<ref name="Lebel-1988">{{Cite journal | last1 = Lebel | first1 = MH. | last2 = Freij | first2 = BJ. | last3 = Syrogiannopoulos | first3 = GA. | last4 = Chrane | first4 = DF. | last5 = Hoyt | first5 = MJ. | last6 = Stewart | first6 = SM. | last7 = Kennard | first7 = BD. | last8 = Olsen | first8 = KD. | last9 = McCracken | first9 = GH. | title = Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials. | journal = N Engl J Med | volume = 319 | issue = 15 | pages = 964-71 | month = Oct | year = 1988 | doi = 10.1056/NEJM198810133191502 | PMID = 3047581 }}</ref><ref name="Odio-1991">{{Cite journal | last1 = Odio | first1 = CM. | last2 = Faingezicht | first2 = I. | last3 = Paris | first3 = M. | last4 = Nassar | first4 = M. | last5 = Baltodano | first5 = A. | last6 = Rogers | first6 = J. | last7 = Sáez-Llorens | first7 = X. | last8 = Olsen | first8 = KD. | last9 = McCracken | first9 = GH. | title = The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis. | journal = N Engl J Med | volume = 324 | issue = 22 | pages = 1525-31 | month = May | year = 1991 | doi = 10.1056/NEJM199105303242201 | PMID = 2027357 }}</ref><ref name="Thwaites-2004">{{Cite journal | last1 = Thwaites | first1 = GE. | last2 = Nguyen | first2 = DB. | last3 = Nguyen | first3 = HD. | last4 = Hoang | first4 = TQ. | last5 = Do | first5 = TT. | last6 = Nguyen | first6 = TC. | last7 = Nguyen | first7 = QH. | last8 = Nguyen | first8 = TT. | last9 = Nguyen | first9 = NH. | title = Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. | journal = N Engl J Med | volume = 351 | issue = 17 | pages = 1741-51 | month = Oct | year = 2004 | doi = 10.1056/NEJMoa040573 | PMID = 15496623 }}</ref><ref name="Brouwer-2010">{{Cite journal | last1 = Brouwer | first1 = MC. | last2 = Heckenberg | first2 = SG. | last3 = de Gans | first3 = J. | last4 = Spanjaard | first4 = L. | last5 = Reitsma | first5 = JB. | last6 = van de Beek | first6 = D. | title = Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis. | journal = Neurology | volume = 75 | issue = 17 | pages = 1533-9 | month = Oct | year = 2010 | doi = 10.1212/WNL.0b013e3181f96297 | PMID = 20881273 }}</ref><ref name="Fritz-2012">{{Cite journal | last1 = Fritz | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = van de Beek | first3 = D. | title = Dexamethasone and long-term survival in bacterial meningitis. | journal = Neurology | volume = 79 | issue = 22 | pages = 2177-9 | month = Nov | year = 2012 | doi = 10.1212/WNL.0b013e31827595f7 | PMID = 23152589 }}</ref><ref name="Peltola-2007">{{Cite journal | last1 = Peltola | first1 = H. | last2 = Roine | first2 = I. | last3 = Fernández | first3 = J. | last4 = Zavala | first4 = I. | last5 = Ayala | first5 = SG. | last6 = Mata | first6 = AG. | last7 = Arbo | first7 = A. | last8 = Bologna | first8 = R. | last9 = Miño | first9 = G. | title = Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial. | journal = Clin Infect Dis | volume = 45 | issue = 10 | pages = 1277-86 | month = Nov | year = 2007 | doi = 10.1086/522534 | PMID = 17968821 }}</ref> However, other studies fail to demonstrate a substantial reduction of death or neurological disability.<ref name="van de Beek-2010">{{Cite journal | last1 = van de Beek | first1 = D. | last2 = Farrar | first2 = JJ. | last3 = de Gans | first3 = J. | last4 = Mai | first4 = NT. | last5 = Molyneux | first5 = EM. | last6 = Peltola | first6 = H. | last7 = Peto | first7 = TE. | last8 = Roine | first8 = I. | last9 = Scarborough | first9 = M. | title = Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. | journal = Lancet Neurol | volume = 9 | issue = 3 | pages = 254-63 | month = Mar | year = 2010 | doi = 10.1016/S1474-4422(10)70023-5 | PMID = 20138011 }}</ref><ref name="Peltola-2010">{{Cite journal | last1 = Peltola | first1 = H. | last2 = Roine | first2 = I. | last3 = Fernández | first3 = J. | last4 = González Mata | first4 = A. | last5 = Zavala | first5 = I. | last6 = Gonzalez Ayala | first6 = S. | last7 = Arbo | first7 = A. | last8 = Bologna | first8 = R. | last9 = Goyo | first9 = J. | title = Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol. | journal = Pediatrics | volume = 125 | issue = 1 | pages = e1-8 | month = Jan | year = 2010 | doi = 10.1542/peds.2009-0395 | PMID = 20008417 }}</ref><ref name="Nguyen-2007">{{Cite journal | last1 = Nguyen | first1 = TH. | last2 = Tran | first2 = TH. | last3 = Thwaites | first3 = G. | last4 = Ly | first4 = VC. | last5 = Dinh | first5 = XS. | last6 = Ho Dang | first6 = TN. | last7 = Dang | first7 = QT. | last8 = Nguyen | first8 = DP. | last9 = Nguyen | first9 = HP. | title = Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. | journal = N Engl J Med | volume = 357 | issue = 24 | pages = 2431-40 | month = Dec | year = 2007 | doi = 10.1056/NEJMoa070852 | PMID = 18077808 }}</ref><ref name="Molyneux-2002">{{Cite journal | last1 = Molyneux | first1 = EM. | last2 = Walsh | first2 = AL. | last3 = Forsyth | first3 = H. | last4 = Tembo | first4 = M. | last5 = Mwenechanya | first5 = J. | last6 = Kayira | first6 = K. | last7 = Bwanaisa | first7 = L. | last8 = Njobvu | first8 = A. | last9 = Rogerson | first9 = S. | title = Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial. | journal = Lancet | volume = 360 | issue = 9328 | pages = 211-8 | month = Jul | year = 2002 | doi = | PMID = 12133656 }}</ref> The occurrence of delayed [[cerebral thrombosis]] with dexamethasone therapy has been reported.<ref name="Schut-2009">{{Cite journal | last1 = Schut | first1 = ES. | last2 = Brouwer | first2 = MC. | last3 = de Gans | first3 = J. | last4 = Florquin | first4 = S. | last5 = Troost | first5 = D. | last6 = van de Beek | first6 = D. | title = Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis. | journal = Neurology | volume = 73 | issue = 23 | pages = 1988-95 | month = Dec | year = 2009 | doi = 10.1212/WNL.0b013e3181c55d2e | PMID = 19890068 }}</ref> | |||
* '''In infants and children with ''[[Haemophilus influenzae]]'' type b meningitis''', the IDSA Practice Guideline supports the use of adjunctive '''''[[Dexamethasone]] at 0.15 mg/kg q6h for 2—4 days''''' with the first dose administered 10—20 minutes prior to, or at least concomitant with, the first antimicrobial dose.<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/15494903 15494903]</ref> | |||
* '''In adults with suspected or proven ''[[Streptococcus pneumoniae]]'' meningitis''', the IDSA also recommends '''''[[Dexamethasone]] at 0.15 mg/kg q6h for 2—4 days''''' with the first dose administered 10—20 minutes prior to, or at least concomitant with, the first antimicrobial dose. Dexamethasone should only be continued if the [[CSF]] [[Gram stain]] reveals [[Gram-positive]] [[diplococci]], or if blood or CSF cultures are positive for ''[[Streptococcus pneumoniae|S. pneumoniae]]''. In this scenario, certain authorities advocate the addition of [[rifampin]] to the empirical combination of [[vancomycin]] plus a third-generation [[cephalosporin]] pending culture results and ''in vitro'' [[susceptibility testing]].<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/15494903 15494903]</ref><ref name="pmid16394301">van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16394301 Community-acquired bacterial meningitis in adults.] ''N Engl J Med'' 354 (1):44-53. [http://dx.doi.org/10.1056/NEJMra052116 DOI:10.1056/NEJMra052116] PMID: [http://pubmed.gov/16394301 16394301]</ref> | |||
* [[Dexamethasone]] should not be given to patients who have already received animicrobial therapy because it is unlikely to improve clinical outcome.<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/15494903 15494903]</ref> | |||
==Empiric Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Lancet. 2012;380(9854):1693-702.''<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> and ''N Engl J Med. 2010;362(2):146-54.''<ref name="van de Beek-2010">{{Cite journal | last1 = van de Beek | first1 = D. | last2 = Drake | first2 = JM. | last3 = Tunkel | first3 = AR. | title = Nosocomial bacterial meningitis. | journal = N Engl J Med | volume = 362 | issue = 2 | pages = 146-54 | month = Jan | year = 2010 | doi = 10.1056/NEJMra0804573 | PMID = 20071704 }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>== | |||
{| | |||
| valign=top | | |||
<div style="height: 30px; line-height: 30px; width: 225px; background: #A5B2D6; border: 2px solid #696969; border-bottom: 0px; text-align: center;">'''Community-Acquired'''</div> | |||
<div class="mw-customtoggle-table01" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Newborns, Age <1 Week'''</font></div> | |||
<div class="mw-customtoggle-table02" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Newborns, Age 1—4 Weeks'''</font></div> | |||
<div class="mw-customtoggle-table03" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Infants & Children'''</font></div> | |||
<div class="mw-customtoggle-table04" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Adults, Age <50 Years'''</font></div> | |||
<div class="mw-customtoggle-table05" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Adults, Age >50 Years'''</font></div> | |||
<div class="mw-customtoggle-table06" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Immunocompromised'''</font></div> | |||
<div class="mw-customtoggle-table07" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Recurrent'''</font></div> | |||
<div style="height: 30px; line-height: 30px; width: 225px; background: #A5B2D6; border: 2px solid #696969; border-bottom: 0px; text-align: center;"> '''Nosocomial'''</div> | |||
<div class="mw-customtoggle-table08" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Postneurosurgical Infection'''</font></div> | |||
<div class="mw-customtoggle-table09" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''CSF Shunt Infection'''</font></div> | |||
<div class="mw-customtoggle-table10" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Penetrating Trauma'''</font></div> | |||
<div class="mw-customtoggle-table11" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid#696969;"> ▸ <font color="#1F4099">'''Basilar Skull Fracture'''</font></div> | |||
| valign=top | | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Newborns, Age <1 Week}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 50 mg/kg IV q8—12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q12h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Newborns, Age 1—4 Weeks}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 50 mg/kg IV q6—8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; 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''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Infants & Children}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''<sup>†</sup> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 75 mg/kg IV q6—8h''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 80—100 mg/kg/day IV q12—24h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen''<sup>†</sup> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 40 mg/kg IV q8h''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL><sup>†</sup> Add '''''[[Ampicillin]] 75 mg/kg IV q6h''''' if suspecting ''[[Listeria monocytogenes]]''.</SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Adults, Age <50 Years}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen''<sup>†</sup> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen''<sup>†</sup> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h''''' | |||
|- | |||
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | <SMALL><sup>†</sup> Add '''''[[Ampicillin]] 2 g IV q4h''''' if suspecting ''[[Listeria monocytogenes]]''.</SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Adults, Age >50 Years}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Immunocompromised}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Recurrent}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Postneurosurgical Infection}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|CSF Shunt Infection}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Penetrating Trauma}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Basilar Skull Fracture}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h''''' | |||
|- | |||
|} | |||
|} | |||
|} | |||
==CSF Gram Stain-Based Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Lancet. 2012;380(9854):1693-702.''<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> and ''Clin Infect Dis. 2004;39(9):1267-84.''<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref></SMALL></SMALL></SMALL></SMALL></SMALL>== | |||
{| | |||
| valign=top | | |||
<div style="height: 30px; line-height: 30px; width: 225px; background: #A5B2D6; border: 2px solid #696969; border-bottom: 0px; text-align: center;">'''Gram-Positive'''</div> | |||
<div class="mw-customtoggle-table12" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Gram-Positive Cocci in Chains'''</font></div> | |||
<div class="mw-customtoggle-table13" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Gram-Positive Cocci in Pairs'''</font></div> | |||
<div class="mw-customtoggle-table14" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Gram-Positive (Cocco-)Bacilli'''</font></div> | |||
<div style="height: 30px; line-height: 30px; width: 225px; background: #A5B2D6; border: 2px solid #696969; border-bottom: 0px; text-align: center;"> '''Gram-Negative'''</div> | |||
<div class="mw-customtoggle-table15" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Gram-Negative Cocci in Pairs'''</font></div> | |||
<div class="mw-customtoggle-table16" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''Gram-Negative Coccobacilli'''</font></div> | |||
<div class="mw-customtoggle-table17" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid#696969;"> ▸ <font color="#1F4099">'''Gram-Negative Bacilli'''</font></div> | |||
| valign=top | | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Gram-Positive Cocci in Chains}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Gram-Positive Cocci in Pairs}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table14" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Gram-Positive (Cocco-)Bacilli}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Gram-Negative Cocci in Pairs}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Gram-Negative Coccobacilli}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table17" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|Gram-Negative Bacilli}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL> | |||
|- | |||
|} | |||
|} | |||
|} | |||
==Pathogen-Based Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Lancet. 2012;380(9854):1693-702.''<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> and ''Clin Infect Dis. 2004;39(9):1267-84.''<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref></SMALL></SMALL></SMALL></SMALL></SMALL>== | |||
{| | |||
| valign=top | | |||
<div style="height: 30px; line-height: 30px; width: 225px; background: #A5B2D6; border: 2px solid #696969; border-bottom: 0px; text-align: center;">'''Bacteria'''</div> | |||
<div class="mw-customtoggle-table18" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''''Acinetobacter baumannii'''''</font></div> | |||
<div class="mw-customtoggle-table19" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''''Enterobacteriaceae'''''</font></div> | |||
<div class="mw-customtoggle-table20" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''''Haemophilus influenzae'''''</font></div> | |||
<div class="mw-customtoggle-table21" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''''Listeria monocytogenes'''''</font></div> | |||
<div class="mw-customtoggle-table22" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''''Neisseria meningitidis'''''</font></div> | |||
<div class="mw-customtoggle-table23" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''''Pseudomonas aeruginosa'''''</font></div> | |||
<div class="mw-customtoggle-table24" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''''Staphylococcus aureus'''''</font></div> | |||
<div class="mw-customtoggle-table25" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''''Staphylococcus epidermidis'''''</font></div> | |||
<div class="mw-customtoggle-table26" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid #696969; border-bottom: 0px;"> ▸ <font color="#1F4099">'''''Streptococcus agalactiae'''''</font></div> | |||
<div class="mw-customtoggle-table27" style="cursor:pointer; height: 30px; line-height: 30px; width: 225px; background: #F8F8FF; border: 2px solid#696969;"> ▸ <font color="#1F4099">'''''Streptococcus pneumoniae'''''</font></div> | |||
| valign=top | | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table18" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''Acinetobacter baumannii''}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Colistin]] 1.25 mg/kg IV q6—12h'''''<BR> OR <BR> ▸ '''''[[Polymyxin B]] 0.75—1.25 mg/kg IV q12h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table19" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''Enterobacteriaceae''}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table20" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''H. influenzae'', β-lactamase Negative}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | |||
|- | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''H. influenzae'', β-lactamase Positive}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | |||
|- | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''H. influenzae'', β-lactamase Negative, Ampicillin Resistant}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table21" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''Listeria monocytogenes''}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table22" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''N. meningitidis'', Penicillin MIC <0.1 μg/mL}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h''''' | |||
|- | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''N. meningitidis'', Penicillin MIC ≥0.1 μg/mL}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table23" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''Pseudomonas aeruginosa''}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table24" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''Staphylococcus aureus'', Methicillin sensitive}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 1.5—2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Oxacillin]] 1.5—2 g IV q4h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL><BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h''''' | |||
|- | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''Staphylococcus aureus'', Methicillin resistant}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table25" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''Staphylococcus epidermidis''}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg IV q12h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table26" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''Streptococcus agalactiae''}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
|} | |||
|} | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table27" style="border: 2px solid #696969;" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 400px;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''S. pneumoniae'', Penicillin MIC ≤0.06 μg/mL}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h''''' | |||
|- | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''S. pneumoniae'', Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC <1.0 μg/mL}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | |||
|- | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | {{fontcolor|#1F4099|''S. pneumoniae'', Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC ≥1.0 μg/mL}} | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Preferred Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h''''' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h''''' | |||
|- | |||
! style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=left | ''Alternative Regimen'' | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL> | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS | |||
|- | |||
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg IV q24h''''' | |||
|- | |||
|} | |||
|} | |||
|} | |||
==References== | |||
{{Reflist|2}} | |||
[[Category:Wikinfect]] | |||
[[Category:Infectious disease]] | |||
[[Category:Primary care]] | |||
[[Category:Neurology]] | |||
[[Category:Emergency medicine]] |
Revision as of 15:26, 24 January 2014
Meningitis Main Page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [3], Sheng Shi, M.D. [4]
Principles of Therapy for Bacterial Meningitis
Overview
- Acute bacterial meningitis is a medical emergency; commence empiric treatment after obtaining blood and/or cerebrospinal fluid (CSF) cultures if the possibility of bacterial meningitis becomes evident. Once a bacterial etiology has been identified on a CSF Gram stain, treatment regimen should be optimized accordingly. Further modifications may be required after the culture and/or in vitro susceptibility results are available.
- Neuroimaging (such as CT scan and MRI) or lumbar puncture must not delay antimicrobial therapy.
Factors Determining Antimicrobial Activity
- Factors determine the acitivity of antimicrobial agents include pharmacodynamics, pharmacokinetics, penetration into the CSF, and bactericidal activity within the CSF.[1]
- Beta-lactams, aminoglycosides, glycopeptides, linezolid, and daptomycin are considered to have poor penetration into the CSF, while fluoroquinolones, chloramphenicol, aztreonam, and tigecycline generally achieve minimum inhibitory concentration (MIC) in the CSF at standard dosage.[2]
- Aminoglycosides and fluoroquinolones express a concentration-dependent manner of bactericidal activity; beta-lactams typically follow a a time-dependent antimicrobial pattern (i.e., the activity is dependent on the time that CSF concentration exceeds MIC as a proportion of the dosing interval).
- Penetration into the CSF is less prominent for drugs with a high molecular weight, high protein-binding ability, low lipid solubility, and drugs that are subject to active transport in the choroid plexus such as penicillins and cephalosporins. Toxicity due to dose escalation may limit the usage the aminoglycosides, glycopeptides, and polymyxins, thus intrathecal or intraventricular administration might be occasionally required (see table below).
Antimicrobial Agent | Daily Intraventricular Dose |
▸ Vancomycin | 5—20 mg |
▸ Gentamicin | 4—8 mg |
▸ Tobramycin | 5—20 mg |
▸ Amikacin | 5—50 mg |
▸ Polymyxin B | 5 mg |
▸ Colistin | 10 mg |
▸ Quinupristin/Dalfopristin | 2—5 mg |
▸ Teicoplanin | 5—40 mg |
▸ Amphotericin B | 0.1—0.5 mg/day |
Duration of Antimicrobial Therapy
- The duration of therapy in patients with bacterial meningitis has not been well-supported by evidence-based data.
- The IDSA Practice Guideline provides recommendations on the duration of antimicrobial agents based on microorganisms (see table below). However, the duration of antimicrobial therapy should be individualized in accordance with patient's clinical response.
- Maximum parenteral dosage should be maintained throughout the recommended duration of therapy to ensure adequate bactericidal concentrations are attained since antimicrobial entry attenuates as meningeal inflammation subsides, especially when dexamethasone is co-administered.
Microorganism | Duration of Therapy |
▸ Neisseria meningitidis | 7 days |
▸ Haemophilus influenzae | 7 days |
▸ Streptococcus pneumoniae | 10—14 days |
▸ Streptococcus agalactiae | 14—21 days |
▸ Aerobic Gram-negative bacilli | 21 days |
▸ Listeria monocytogenes | ≥21 days |
Adjunctive Dexamethasone Therapy
- Evidences for beneficial effects of dexamethasone are variable. In some studies, adjunctive use of dexamethasone for bacterial meningitis in selected groups are associated with an improved survival or prognosis.[7][8][9][10][11][12] However, other studies fail to demonstrate a substantial reduction of death or neurological disability.[3][13][14][15] The occurrence of delayed cerebral thrombosis with dexamethasone therapy has been reported.[16]
- In infants and children with Haemophilus influenzae type b meningitis, the IDSA Practice Guideline supports the use of adjunctive Dexamethasone at 0.15 mg/kg q6h for 2—4 days with the first dose administered 10—20 minutes prior to, or at least concomitant with, the first antimicrobial dose.[6]
- In adults with suspected or proven Streptococcus pneumoniae meningitis, the IDSA also recommends Dexamethasone at 0.15 mg/kg q6h for 2—4 days with the first dose administered 10—20 minutes prior to, or at least concomitant with, the first antimicrobial dose. Dexamethasone should only be continued if the CSF Gram stain reveals Gram-positive diplococci, or if blood or CSF cultures are positive for S. pneumoniae. In this scenario, certain authorities advocate the addition of rifampin to the empirical combination of vancomycin plus a third-generation cephalosporin pending culture results and in vitro susceptibility testing.[6][17]
- Dexamethasone should not be given to patients who have already received animicrobial therapy because it is unlikely to improve clinical outcome.[6]
Empiric Therapy Adapted from Lancet. 2012;380(9854):1693-702.[18] and N Engl J Med. 2010;362(2):146-54.[3]
Community-Acquired
▸ Newborns, Age <1 Week
▸ Newborns, Age 1—4 Weeks
▸ Infants & Children
▸ Adults, Age <50 Years
▸ Adults, Age >50 Years
▸ Immunocompromised
▸ Recurrent
Nosocomial
▸ Postneurosurgical Infection
▸ CSF Shunt Infection
▸ Penetrating Trauma
▸ Basilar Skull Fracture
|
|
CSF Gram Stain-Based Therapy Adapted from Lancet. 2012;380(9854):1693-702.[18] and Clin Infect Dis. 2004;39(9):1267-84.[6]
Gram-Positive
▸ Gram-Positive Cocci in Chains
▸ Gram-Positive Cocci in Pairs
▸ Gram-Positive (Cocco-)Bacilli
Gram-Negative
▸ Gram-Negative Cocci in Pairs
▸ Gram-Negative Coccobacilli
▸ Gram-Negative Bacilli
|
|
Pathogen-Based Therapy Adapted from Lancet. 2012;380(9854):1693-702.[18] and Clin Infect Dis. 2004;39(9):1267-84.[6]
Bacteria
▸ Acinetobacter baumannii
▸ Enterobacteriaceae
▸ Haemophilus influenzae
▸ Listeria monocytogenes
▸ Neisseria meningitidis
▸ Pseudomonas aeruginosa
▸ Staphylococcus aureus
▸ Staphylococcus epidermidis
▸ Streptococcus agalactiae
▸ Streptococcus pneumoniae
|
|
References
- ↑ Andes, DR.; Craig, WA. (1999). "Pharmacokinetics and pharmacodynamics of antibiotics in meningitis". Infect Dis Clin North Am. 13 (3): 595–618. PMID 10470557. Unknown parameter
|month=
ignored (help) - ↑ Nau, R.; Sörgel, F.; Eiffert, H. (2010). "Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections". Clin Microbiol Rev. 23 (4): 858–83. doi:10.1128/CMR.00007-10. PMID 20930076. Unknown parameter
|month=
ignored (help) - ↑ 3.0 3.1 3.2 van de Beek, D.; Drake, JM.; Tunkel, AR. (2010). "Nosocomial bacterial meningitis". N Engl J Med. 362 (2): 146–54. doi:10.1056/NEJMra0804573. PMID 20071704. Unknown parameter
|month=
ignored (help) - ↑ Rodríguez Guardado, A.; Blanco, A.; Asensi, V.; Pérez, F.; Rial, JC.; Pintado, V.; Bustillo, E.; Lantero, M.; Tenza, E. (2008). "Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments". J Antimicrob Chemother. 61 (4): 908–13. doi:10.1093/jac/dkn018. PMID 18281693. Unknown parameter
|month=
ignored (help) - ↑ Cruciani, M.; Navarra, A.; Di Perri, G.; Andreoni, M.; Danzi, MC.; Concia, E.; Bassetti, D. (1992). "Evaluation of intraventricular teicoplanin for the treatment of neurosurgical shunt infections". Clin Infect Dis. 15 (2): 285–9. PMID 1387805. Unknown parameter
|month=
ignored (help) - ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39 (9):1267-84. DOI:10.1086/425368 PMID: [1]
- ↑ Lebel, MH.; Freij, BJ.; Syrogiannopoulos, GA.; Chrane, DF.; Hoyt, MJ.; Stewart, SM.; Kennard, BD.; Olsen, KD.; McCracken, GH. (1988). "Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials". N Engl J Med. 319 (15): 964–71. doi:10.1056/NEJM198810133191502. PMID 3047581. Unknown parameter
|month=
ignored (help) - ↑ Odio, CM.; Faingezicht, I.; Paris, M.; Nassar, M.; Baltodano, A.; Rogers, J.; Sáez-Llorens, X.; Olsen, KD.; McCracken, GH. (1991). "The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis". N Engl J Med. 324 (22): 1525–31. doi:10.1056/NEJM199105303242201. PMID 2027357. Unknown parameter
|month=
ignored (help) - ↑ Thwaites, GE.; Nguyen, DB.; Nguyen, HD.; Hoang, TQ.; Do, TT.; Nguyen, TC.; Nguyen, QH.; Nguyen, TT.; Nguyen, NH. (2004). "Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults". N Engl J Med. 351 (17): 1741–51. doi:10.1056/NEJMoa040573. PMID 15496623. Unknown parameter
|month=
ignored (help) - ↑ Brouwer, MC.; Heckenberg, SG.; de Gans, J.; Spanjaard, L.; Reitsma, JB.; van de Beek, D. (2010). "Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis". Neurology. 75 (17): 1533–9. doi:10.1212/WNL.0b013e3181f96297. PMID 20881273. Unknown parameter
|month=
ignored (help) - ↑ Fritz, D.; Brouwer, MC.; van de Beek, D. (2012). "Dexamethasone and long-term survival in bacterial meningitis". Neurology. 79 (22): 2177–9. doi:10.1212/WNL.0b013e31827595f7. PMID 23152589. Unknown parameter
|month=
ignored (help) - ↑ Peltola, H.; Roine, I.; Fernández, J.; Zavala, I.; Ayala, SG.; Mata, AG.; Arbo, A.; Bologna, R.; Miño, G. (2007). "Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial". Clin Infect Dis. 45 (10): 1277–86. doi:10.1086/522534. PMID 17968821. Unknown parameter
|month=
ignored (help) - ↑ Peltola, H.; Roine, I.; Fernández, J.; González Mata, A.; Zavala, I.; Gonzalez Ayala, S.; Arbo, A.; Bologna, R.; Goyo, J. (2010). "Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol". Pediatrics. 125 (1): e1–8. doi:10.1542/peds.2009-0395. PMID 20008417. Unknown parameter
|month=
ignored (help) - ↑ Nguyen, TH.; Tran, TH.; Thwaites, G.; Ly, VC.; Dinh, XS.; Ho Dang, TN.; Dang, QT.; Nguyen, DP.; Nguyen, HP. (2007). "Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis". N Engl J Med. 357 (24): 2431–40. doi:10.1056/NEJMoa070852. PMID 18077808. Unknown parameter
|month=
ignored (help) - ↑ Molyneux, EM.; Walsh, AL.; Forsyth, H.; Tembo, M.; Mwenechanya, J.; Kayira, K.; Bwanaisa, L.; Njobvu, A.; Rogerson, S. (2002). "Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial". Lancet. 360 (9328): 211–8. PMID 12133656. Unknown parameter
|month=
ignored (help) - ↑ Schut, ES.; Brouwer, MC.; de Gans, J.; Florquin, S.; Troost, D.; van de Beek, D. (2009). "Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis". Neurology. 73 (23): 1988–95. doi:10.1212/WNL.0b013e3181c55d2e. PMID 19890068. Unknown parameter
|month=
ignored (help) - ↑ van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (2006) Community-acquired bacterial meningitis in adults. N Engl J Med 354 (1):44-53. DOI:10.1056/NEJMra052116 PMID: 16394301
- ↑ 18.0 18.1 18.2 van de Beek, D.; Brouwer, MC.; Thwaites, GE.; Tunkel, AR. (2012). "Advances in treatment of bacterial meningitis". Lancet. 380 (9854): 1693–702. doi:10.1016/S0140-6736(12)61186-6. PMID 23141618. Unknown parameter
|month=
ignored (help)