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.[1]
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

  1. Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ (2004). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903. Retrieved 2012-11-28. Unknown parameter |month= ignored (help)


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