| Meningitis |
Possible therapeutic alternatives |
| Empiric therapy (Age < 50 years) |
Common pathogens |
(Cefotaxime 2 grams IVPB q4h or Ceftriaxone 2 grams IVPB q12h)
+
dexamethasone (0.4mg/kg q12h or 0.15 mg/kg IV q6h x 2 days given 30 minutes prior to antibiotics)
+
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
May also add Rifampin 600mg po qd or 300mg po bid. |
Alternative:
meropenem 2 gram IV q8h
+
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
+
Dexamethasone (0.15 mg/kg IV q6h x 2 to 4 days given 30 minutes prior to antibiotics)
| Meropenem - Renal dosing |
|
Creatinine Clearance
(mL/min) |
Dose (dependent on type of infection) |
Dosing Interval |
| > 50 |
Recommended dose (2 g meningitis) |
Every 8 hours |
| > 25-50 |
Recommended dose |
Every 12 hours |
| 10-25 |
One-half recommended dose |
Every 12 hours |
| < 10 |
One-half recommended dose |
Every 24 hours |
|
| If severe penicillin allergy: |
Chloramphenicol 1g IV q6h(12.5 mg/kg IV q6h (max. 4 gm/day)
+
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
+/-
Rifampin. |
|
| Age > 50 years or alcoholism or other debilitating disease. |
Common pathogens |
Ampicillin 2g IV q4h
+
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
+
[Cefotaxime 2g IV q4-6h or Ceftriaxone 2g IV q12-24h ]
+
Dexamethasone (0.15 mg/kg IV q6h x 2 to 4 days given 30 minutes prior to antibiotics) |
Alternative:
meropenem 2 gram IV q8h
+
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
+
Dexamethasone (0.15 mg/kg IV q6h x 2 to 4 days given 30 minutes prior to antibiotics)
| Meropenem - Renal dosing |
|
Creatinine Clearance
(mL/min) |
Dose (dependent on type of infection) |
Dosing Interval |
| > 50 |
Recommended dose (2 g meningitis) |
Every 8 hours |
| > 25-50 |
Recommended dose |
Every 12 hours |
| 10-25 |
One-half recommended dose |
Every 12 hours |
| < 10 |
One-half recommended dose |
Every 24 hours |
|
| If severe penicillin allergy: |
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
+
Bactrim 15-20 mg/kg/day in 4 divided doses pending culture results. or |
[Chloramphenicol 1g IV q6h(12.5 mg/kg IV q6h (max. 4 gm/day)
+
Vancomycin 1 gram ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)
+/-
rifampin 300mg PO or IV bid] |
|
| Trauma or post neurosurgery |
Common pathogens |
Vancomycin 1 gram IVPB q6-12h +
Ceftazidime 2 grams IVPB q8h.
// If gram negative bacilli are suspected add Gentamycin IVPB +/- intrathecally. |
|
| Impaired cellular immunity |
Common pathogens |
Ampicillin 2 grams IVPB q4h +
Ceftazidime 2 grams IVPB q8h. |
| If severe penicillin allergy: |
| Bactrim 15-20mg/kg/day in 4 divided doses. May add Gentamicin. |
| If Listeria present: cephalosporins are not effective. |
|
| N.meningitidis confirmed |
|
| Penicillin G 4 million units IVPB q4h. |
| If severe penicillin allergy: |
| Chloramphenicol 1g IV q6h (12.5 mg/kg IV q6h (max. 4 gm/day) |
|
