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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]

Penicillin MIC ≤0.06 μg/mL
Preferred Regimen
▸ Penicillin G Low: 600,000–1.2 million units/day IM; High:≥ 20 million units IV q24h(=12 g) OR ▸ Ampicillin 150–200 mg/kg IV q3-4h
Alternative Regimen
▸ Cefotaxime 1 g q8–12h to 2 g IV q4h OR ▸ Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine) OR ▸ Chloramphenicol 0.25–1 g po IV q6h to max. of 4 g/day

Penicillin MIC ≥0.12 μg/mL
Cefotaxime or Ceftriaxone MIC† <1.0 μg/mL
Preferred Regimen
▸ Cefotaxime 1 g q8–12h to 2 g IV q4h OR ▸ Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
Alternative Regimen
▸ Cefepime 1–2 g IV q12h OR ▸ Meropenem 2 g IV q8h
Cefotaxime or Ceftriaxone MIC† >1.0 μg/mL
Preferred Regimen
▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )
AND
▸ Cefotaxime 1 g q8–12h to 2 g IV q4h OR ▸ Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)^‡
Alternative Regimen
▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )
AND
▸ Moxiﬂoxacin 400 mg po IV q24h ^ɸ

Neisseria meningitidis
Penicillin MIC <0.1 μg/mL
Preferred Regimen
▸ Penicillin G Low: 600,000–1.2 million units/day IM; High:≥ 20 million units IV q24h(=12 g) OR ▸ Ampicillin 0.25–0.5 g po q6h.150–200 mg/kg/day IV
Alternative Regimen
▸ Cefotaxime 1 g q8–12h to 2 g IV q4h OR ▸ Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine) OR ▸ Chloramphenicol 0.25–1 g po IV q6h to max. of 4 g/day

Neisseria meningitidis
Penicillin MIC ≥0.1 μg/mL
Preferred Regimen
▸ Cefotaxime 1 g q8–12h to 2 g IV q4h OR ▸ Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
Alternative Regimen
▸ Cefepime 1–2 g IV q12h OR ▸ Chloramphenicol 0.25–1 g po IV q6h to max. of 4 g/day OR ▸ Fluoroquinolone^Δ OR ▸ Meropenem 2 g IV q8h

Listeria Monocytogenes
Preferred Regimen
▸ Ampicillin 0.25–0.5 g po q6h.150–200 mg/kg/day IV OR ▸ Penicillin G Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 g)^£
Alternative Regimen
▸ Trimethoprim-sulfamethoxazole 5–20 mg/kg/day q6-12h

Streptococcus agalactiae
Preferred Regimen
▸ Ampicillin 0.25–0.5 g po q6h.150–200 mg/kg/day IV OR ▸ Penicillin G Low: 600,000–1.2 million units/day IM ;High:≥ 20 million units IV q24h(=12 g)^£
Alternative Regimen
▸ Cefotaxime 1 g q8–12h to 2 g IV q4h OR ▸ Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine) OR ▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )

Haemophilus inﬂuenzae β-lactamase negative
Preferred Regimen
▸ Ampicillin 0.25–0.5 g po q6h.150–200 mg/kg/day IV
Alternative Regimen
▸ Cefotaxime 1 g q8–12h to 2 g IV q4h OR ▸ Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine) OR ▸ Cefepime 1–2 g IV q12h OR ▸ Chloramphenicol 0.25–1 g po IV q6h to max. of 4 g/day OR ▸ Aztreonam 1 g IV q8h–2 g IV q6h OR ▸ Fluoroquinolone^Δ
β-lactamase negative, ampicillin resistant
Preferred Regimen
▸ Meropenem 2 g IV q8h
Alternative Regimen
▸ Fluoroquinolone^Δ

Haemophilus inﬂuenzae β-lactamase positive
Preferred Regimen
▸ Cefotaxime 1 g q8–12h to 2 g IV q4h OR ▸ Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
Alternative Regimen
▸ Cefepime 1–2 g IV q12h OR ▸ Chloramphenicol 0.25–1 g po IV q6h to max. of 4 g/day OR ▸ Aztreonam 1 g q8h–2 g IV q6h OR ▸ Fluoroquinolone^Δ

Staphylococcus aureus Meticillin sensitive
Preferred Regimen
▸ Nafcillin 1–2 g IV/IM q4h OR ▸ Oxacillin 1–2 g IV/IM q4h
Alternative Regimen
▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. ) OR ▸ linezolid 600 mg IV/PO q12h OR ▸ Daptomycin 6 mg/kg IV q24h

Staphylococcus aureus Meticillin resistant^₦
Preferred Regimen
▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )
Alternative Regimen
▸ Trimethoprim-sulfamethoxazole 5–20 mg/kg/day q6-12h OR ▸ linezolid 600 mg IV/PO q12h OR ▸ Daptomycin 6 mg/kg IV q24h

Staphylococcus epidermidis^₦
Preferred Regimen
▸ Vancomycin give loading dose of 25-30 mg/kg IV then 15-20 mg/kg IV q8-12h(Target trough level is 15-20 µg/mL. For individual doses over 1 gm, infuse over 1.5-2 hrs. )
Alternative Regimen
▸ *Linezolid 600 mg IV/PO q12h*

Acinetobacter baumannii
Preferred Regimen
▸ Meropenem 2 g IV q8h
Alternative Regimen
▸ Colistin in US:2.5-5 mg/kg/day q6-12h( 6.7-13.3 mg/kg/day of colistimethate sodium (CMS),max 800 mg/day); Elsewhere: ≤60 kg, 50,000-75,000 IU/kg/day IV q8h (=4-6 mg/kg per day of CMS). >60 kg, 1-2 mill IU IV q8h (= 80-160 mg IV tid). OR ▸ *Polymyxin B 15,000–25,000 units/kg/day q12h^ǂ*

Enterobacteriaceae^Ω
Preferred Regimen
▸ Cefotaxime 1 g q8–12h to 2 g IV q4h OR ▸ Ceftriaxone 1 g IV qd (2 g IV q12h for Purulent meningitis also IM in 1% lidocaine)
Alternative Regimen
▸ Aztreonam 1 g q8h–2 g IV q6h OR ▸ Fluoroquinolone^Δ OR ▸ Trimethoprim-sulfamethoxazole 5–20 mg/kg/day q6-12h OR ▸ Meropenem 2 g IV q8h OR ▸ Ampicillin 150–200 mg/kg/day IV

Pseudomonas aeruginosa
Preferred Regimen
▸ Ceftazidime 1–2 g IV/IM q8–12h OR ▸ Cefepime 1–2 g IV q12h^£
Alternative Regimen
▸ Aztreonam 1 g q8h–2 g IV q6h OR ▸ Meropenem 2 g IV q8h OR ▸ Ciproﬂoxacin 500-750 mg po bid^£

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