Sandbox/v45

Empiric Therapy Adapted from Lancet. 2012;380(9854):1693-702.^[1] and N Engl J Med. 2010;362(2):146-54.^[2]

Community-Acquired

▸ Newborns, Age <1 Week

▸ Newborns, Age 1—4 Weeks

▸ Infants & Children

▸ Adults, Age <50 Years

▸ Adults, Age >50 Years

▸ Immunocompromised

▸ Recurrent

Nosocomial

▸ Postneurosurgical Infection

▸ CSF Shunt Infection

▸ Penetrating Trauma

▸ Basilar Skull Fracture

Newborns, Age 1—4 Weeks
Preferred Regimen
▸ Ampicillin 200 mg/kg/day IV q6—8h
PLUS
▸ Cefotaxime 50 mg/kg IV q6—8h
Alternative Regimen
▸ Ampicillin 200 mg/kg/day IV q6—8h
PLUS
▸ Gentamicin 2.5 mg/kg IV q8h OR ▸ Tobramycin 2.5 mg/kg IV q8h OR ▸ Amikacin 10 mg/kg IV q8h

Infants & Children
Preferred Regimen^†
▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL)
PLUS
▸ Cefotaxime 75 mg/kg IV q6—8h OR ▸ Ceftriaxone 80—100 mg/kg/day IV q12—24h
Alternative Regimen^†
▸ Vancomycin 15 mg/kg IV q6h (trough 15—20 μg/mL)
PLUS
▸ Meropenem 40 mg/kg IV q8h
^† Add Ampicillin 75 mg/kg IV q6h if suspecting Listeria monocytogenes.

Adults, Age <50 Years
Preferred Regimen^†
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h
Alternative Regimen^†
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Meropenem 2 g IV q8h
^† Add Ampicillin 2 g IV q4h if suspecting Listeria monocytogenes.

Adults, Age >50 Years
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h
PLUS
▸ Ampicillin 2 g IV q4h
Alternative Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Aztreonam 2 g IV q6—8h
PLUS
▸ TMP/SMZ 5 mg/kg IV q6—12h (TMP component)

Immunocompromised
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Cefepime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h
PLUS
▸ Ampicillin 2 g IV q4h

Recurrent
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h

Postneurosurgical Infection
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Cefepime 2 g IV q8h OR ▸ Ceftazidime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h
Alternative Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h

CSF Shunt Infection
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Cefepime 2 g IV q8h OR ▸ Ceftazidime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h
Alternative Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h

Penetrating Trauma
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Cefepime 2 g IV q8h OR ▸ Ceftazidime 2 g IV q8h OR ▸ Meropenem 2 g IV q8h
Alternative Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h

Basilar Skull Fracture
Preferred Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h
Alternative Regimen
▸ Vancomycin 15 mg/kg IV q8—12h (trough 15—20 μg/mL)
PLUS
▸ Aztreonam 2 g IV q6—8h OR ▸ Ciprofloxacin 400 mg IV q8—12h

↑ van de Beek, D.; Brouwer, MC.; Thwaites, GE.; Tunkel, AR. (2012). "Advances in treatment of bacterial meningitis". Lancet. 380 (9854): 1693–702. doi:10.1016/S0140-6736(12)61186-6. PMID 23141618. Unknown parameter |month= ignored (help)
↑ van de Beek, D.; Drake, JM.; Tunkel, AR. (2010). "Nosocomial bacterial meningitis". N Engl J Med. 362 (2): 146–54. doi:10.1056/NEJMra0804573. PMID 20071704. Unknown parameter |month= ignored (help)