MENINGITIS MANAGEMENT

• <50, immunocompetent

Ceftriaxone 2gm iv q12h  OR Chloramphenicol 1 gm IV q6h   OR Ciprofloxacin 400 mg IV q8h 

Covers Strep pneumoniae (gram positive cocci), Neisseria Meningitidis(gram negative cocci), Hemophilus influenzae (gram negative coccobacilli)

Vancomycin 1gm iv q12  OR Linezolid 600mg IV q12           

Covers Strep pneumoniae

• >50 immunocompetent

Ceftriaxone 2gm iv q12h OR Chloramphenicol 1 gm IV q6h      OR Ciprofloxacin 400 mg IV q8h        

Strep pneumoniae, Neisseria Meningitidis, Hemophilus influenzae

Vancomycin 1gm iv q12 OR Linezolid 600mg IV q12              

Strep pneumoniae

Ampicillin 2gm iv q4h OR TMP/ SMX (Bactrim) 7.5mg/kg  q12h       

Listeria (gram + bacilli)

• Immunocompromised

Cefepime 2 gm IV q8h OR Meropenem 2gm IV q 8h   OR   [ Cipro 400 mg IV q8h   and    Gentamicin 1mg/kg IV q8h   ]

Gram neg bacilli: Pseudomonas, Strep pneumoniae

Vancomycin 1gm iv q12  OR Linezolid 600mg IV q12                  

Strep pneumoniae

Ampicillin 2gm iv q4h OR TMP/ SMX (Bactrim) 7.5mg/kg q12h                                      

Listeria (gram + bacilli)

• Head trauma penetrating, or neurosurgery

Cefepime (4th gen) 2 gm IV q8h OR Meropenem 2gm IV q 8h  OR  Cipro 400 mg IV q8h and Gentamicin 1mg/kg IV q8h    

Gram neg bacilli: Pseudomonas, Strept pneumoniae

Vancomycin 1gm iv q12  OR Linezolid 600mg IV q12                 

Strep pneumoniae, Staph aureus, staph epidermidis

• Infected Shunt

Vancomycin 1gm iv q12  OR    Linezolid 600mg IV q12                 

Staph aureus, staph epidermidis

Cefepime (4th gen) 2 gm IV q8h OR Meropenem 2gm IV q 8h OR Cipro 400 mg IV q8h and Gentamicin 1mg/kg IV q8h    

Gram neg bacilli (RARE IN INFECTED SHUNT) : Pseudomonas, Strept pneumoniae

• Policy on steroid use

Dexamethasone 0.15mg/kg iv q6h x 3 days first dose 20 minutes before first dose of AB. Continue only for gram positive diplococci, ie Strep pneumoniae

• Basic drug susceptibilities

Ceftriaxone OR Chloramphenicol or Ciprofloxacin  are effective against Neisseria Meningitidis and Hemophilus Influenzae

Vancomycin OR Ceftriaxone is effective against Strept Pneumoniae

Bactrim and Ampicillin effective against Listeria

Gram negatives: Meropenem or Cefepime or Cipro + Gent

• Duration of treatment:

Gram negative bacteria : 3 weeks

Listeria: 3 weeks

Strep pneumoniae : 2 weeks

Neisseria Meningitidis and Hemophilus Influenzae: 1 week