Meningitis medical therapy
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Meningitis Main Page |
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 |
Streptococcus pneumonia (if CSF leak), Hemophilus influenzae, Staphylococci, (Gram-negatives) |
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| Shunt infection |
Pathogen Specific Treatment
- Shown below is a table summarizing the treatment of meningitis depending on the specific pathogen.