Meningitis medical therapy

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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]

Overview

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
Shunt infection

Pathogen Specific Treatment

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

References


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