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Specific treatment in patients with suspected meningitis
What specific empirical antimicrobial agent(s) should be used in patients with suspected meningitis?
Empiric Antimicrobial Coverage for Meningitis/Encephalitis
| Predisposing Factor | Common Bacterial Pathogens | Antimicrobial Therapy |
|---|---|---|
| 2-50 years of age | Neisseria meningitidis , Streptococcus pneumoniae | Vancomycin plus a third-generation cephalosporin ∗ , † |
| >50 years | S. pneumoniae , N. meningitidis , Listeria monocytogenes , aerobic gram-negative bacilli | Vancomycin plus ampicillin plus a third-generation cephalosporin ∗ , † |
| Basilar skull fracture | S. pneumoniae , Haemophilus influenzae , group A β-hemolytic streptococci | Vancomycin plus a third-generation cephalosporin ∗ |
| Penetrating trauma | Staphylococcus aureus , coagulase-negative staphylococci (especially Staphylococcus epidermidis ), aerobic gram-negative bacilli (including Pseudomonas aeruginosa ) | Vancomycin plus cefepime, vancomycin plus ceftazidime, or vancomycin plus meropenem |
| Post neurosurgery | Aerobic gram-negative bacilli (including P. aeruginosa ), S. aureus , coagulase-negative staphylococci (especially S. epidermidis ) | Vancomycin plus cefepime, vancomycin plus ceftazidime, or vancomycin plus meropenem |
| CSF shunt | Coagulase-negative staphylococci (especially S. epidermidis ), S. aureus , aerobic gram-negative bacilli (including P. aeruginosa ), Propionibacterium acnes | Vancomycin plus cefepime, ‡ vancomycin plus ceftazidime, ‡ or vancomycin plus meropenem ‡ |
CSF , Cerebral spinal fluid.
∗ Ceftriaxone or cefotaxime.
† Some experts would add rifampin if dexamethasone is also given.
‡ In infants and children, vancomycin alone is reasonable unless Gram stains reveal the presence of gram-negative bacilli.
Sources
From Tunkel AR, Hartman BJ, Kaplan SL, et al.: Practice guidelines for the management of bacterial meningitis. Clin Inf Dis 39(9):1267-1284, 2004.
