Template:Meningitis Antibiotics

Neonates (up to 1 month of age)

MRSA is uncommon in the neonate

• Ampicillin 75mg/kg IV q6hrs PLUS
• Cefotaxime 50mg/kg IV q6hrs OR 2.5mg/kg IV q8hrs
  • Per AAP, ceftazidime 50mg/kg IV (q12hr for babies < 8 days of age, q8hr for >7 days old) is a reasonable alternative to cefotaxime, offering virtually the same coverage for enteric bacilli and is FDA approved for all age groups
• If suspecting S. pneumoniae or MRSA, add standard neonatal dosing
• Consider acyclovir for HSV

> 1 month old

• Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
• Vancomycin 15-20 mg/kg IV BID daily
  • Vancomycin is for resistant Pneumococcus

Alternatives (e.g. penicillin/cephalosporin allergy):

• Meropenem 40mg/kg IV q8hrs (max 2g/dose)
• Chloramphenicol 75-100mg/kg/day IV divided q6h (max 4g/day)

Adult < 50 yr

• Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
• Vancomycin 15-20 mg/kg IV BID daily
  • Vancomycin is for resistant Pneumococcus

Adult > 50 yr and Immunocompromised

• Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
• Vancomycin 15-20 mg/kg IV BID daily PLUS
• Ampicillin 2gm IV q4h (hourly if listeria suspected)

Post Procedural (or penetrating trauma)

• Vancomycin 15-20mg/kg IV BID daily PLUS
• Cefepime 2g (50mg/kg) IV q8 hours daily OR Ceftazidime 2g (50mg/kg) IV q8 hours daily OR Meropenem 2gm (40mg/kg) IV q8 hours daily

Cryptococcosis Meningitis

Options

• Amphotericin B 1mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
• Amphotericin B 5mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily

Meningitis with severe PCN allergy

• Chloramphenicol 1g IV q6h + 15mg/kg q8-12hr

Meningitis with VP shunt

• Coverage for skin contaminants (S. epidermis, S. aureus)
• Vancomycin plus ceftriaxone plus shunt removal

Neisseria meningitidis Prophylaxis

• Ceftriaxone 250mg IM once
• Ceftriaxone 125mg IM once (if <=15yr)
• Ciprofloxacin 500mg PO once
• Rifampin 600 mg PO BID x 2 days
• Rifampin <1mo: 5mg/kg PO BID x 2 days; >=1mo: 10mg/kg PO BID x 2 days