Community-acquired bacterial meningitis

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Community-acquired bacterial meningitis
Definition Symptoms Management
Antibiotic Comment
Meningitis is an inflammatory disease of leptomeninges, the tissues surrounding the brain and spinal cord. Fever, neck rigidity, changes in mental status, severe headache, nausea.
Age: 2 - 50 years OR Basilar skull fracture

Vancomycin 15 - 20 mg/kg IV every 8 - 12 hours

PLUS

Select one of the following Antibiotics:

  • Cefotaxime 2 g IV every 4 - 6 hours
  • Ceftriaxone 2 g IV every 12 hours
 Add ampicillin if Listeria monocytogenes is suspected (e.g., pregnancy, glucocorticoid therapy)
Age: > 50 years

Vancomycin 15 - 20 mg/kg IV every 8 - 12 hours

PLUS

Ampicillin 2g IV every 4 hours

PLUS

Select one of the following Antibiotics:

  • Cefotaxime 2 g IV every 4 - 6 hours
  • Ceftriaxone 2 g IV every 12 hours
Penetrating trauma OR Postneurosurgery

Vancomycin 15 - 20 mg/kg IV every 8 - 12 hours

PLUS

Select one of the following Antibiotics:

  • Ceftazidime 2 g IV every 8 hours
  • Cefepime 2 g IV every 8 hours
  • Meropenem 2 g IV every 8 hours
Immunocompromized state (eg, AIDS, lymphoma, patients receiving immunosuppressive agents)

Vancomycin 15 - 20 mg/kg IV every 8 - 12 hours

PLUS

Ampicillin 2g IV every 4 hours

PLUS

Cefepime 2 g IV every 8 hours

OR

Vancomycin 15 - 20 mg/kg IV every 8 - 12 hours

PLUS

Meropenem 2 g IV every 8 hours

 Meropenem provides sufficient coverage for Listeria when used in initial regimen. However, if Listeria is identified, the patient should switch to a regimen that includes ampicillin.
Duration: 10- 14 days according to causative pathogen, may prolonged to 21 days depending on clinical response.
References:

Practice Guidelines for the Management of Bacterial Meningitis, Last update 2018