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Empiric Therapy Adapted from Lancet. 2012;380(9854):1693-702.[1] and Clin Infect Dis. 2004;39(9):1267-84.[2]

▸ Click on the following categories to expand treatment regimens.

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

Gram-Positive Cocci in Chains
Preferred Regimen
Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
Alternative Regimen
Meropenem 2 g IV q8h
OR
Moxifloxacin 400 mg IV q24h
Gram-Positive Cocci in Pairs
Preferred Regimen
Ampicillin 2 g IV q4h
OR
Penicillin G 4 MU IV q4h
PLUS
Gentamicin 1.7 mg/kg IV q8h
Alternative Regimen
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
Gram-Positive (Cocco-)Bacilli
Preferred Regimen
Ampicillin 2 g IV q4h
OR
Penicillin G 4 MU IV q4h
PLUS
Gentamicin 1.7 mg/kg IV q8h
Alternative Regimen
TMP/SMZ 5 mg/kg IV q6—12h (TMP component)
OR
Meropenem 2 g IV q8h
Gram-Negative Cocci in Pairs
Preferred Regimen
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
Alternative Regimen
Penicillin G 4 MU IV q4h
OR
Ampicillin 2 g IV q4h
OR
Chloramphenicol 1—1.5 g IV q6h
OR
Moxifloxacin 400 mg IV q24h
OR
Aztreonam 2 g IV q6—8h
Gram-Negative Coccobacilli
Preferred Regimen
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
Alternative Regimen
Chloramphenicol 1—1.5 g IV q6h
OR
Cefepime 2 g IV q8h
OR
Meropenem 2 g IV q8h
OR
Moxifloxacin 400 mg IV q24h
Gram-Negative Bacilli
Preferred Regimen
Cefotaxime 2 g IV q4—6h
OR
Ceftriaxone 2 g IV q12h
Alternative Regimen
Cefepime 2 g IV q8h
OR
Meropenem 2 g IV q8h
OR
Aztreonam 2 g IV q6—8h
OR
Moxifloxacin 400 mg IV q24h
OR
TMP/SMZ 5 mg/kg IV q6—12h (TMP component)


References

  1. 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)
  2. 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]