Health care-associated bacterial meningitis

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Health care-associated bacterial meningitis
Definition Signs/ Symptoms Management
Initial Empirical Therapy Comment
Health care-associated meningitis can occur as complication of neurosurgery, placement of CSF shunt or external ventricular drain , intrathecal pump or deep brain stimulator and following dural puncture. Fever, neck rigidity, changes in mental status, severe headache ,nausea/vomitting, seizures, photophobia.
  • Vancomycin loading dose 20 - 35 mg/kg followed by 15 - 20 mg/kg IV every 8 - 12 hours

Plus:

Select one of the following:

  • Ceftazidime 2 g IV every 8 hours
  • Cefepime 2 g IV every 8 hours
  • Meropenem 2 g IV every 8 hours
Meropenem is the preferred choice for empiric therapy in patients who have a history of infection with ESBL- producing Gram negative bacillus, or at institutions that have high prevalence of such pathogen.
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