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__NOTOC__
{{Meningitis}}
{{CMG}}; {{AE}} {{SS}}
==Medical Therapy==
====Empiric Treatment====
======Community-acquired meningitis======
{|
{|
|-
|-
| valign=top |
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:19em" cellpadding="0" cellspacing="0";
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:32em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Age <1 Week}}''
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|H. Influenzae}}''
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 50 mg/kg IV q12h'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''If [[Penicillin]] Allergic''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 100—150 mg/kg/day IV q8—12h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Chloramphenicol]] 12.5 mg/kg IV q6h (max. 4 gm/day.)'''''
|-
|-
 
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Listeria Monocytogenes}}''
 
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h'''''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin ]] 50 mg/kg IV q12h 2mg iv q4h'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q12h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS OR NOT''
|-
|-
|}
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[gentamicin]] 2 mg/kg loading dose then 1.7kg/mg q8h'''''  
 
 
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:19em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Age >50 years}}''
|-
|-
 
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''If [[Penicillin]] Allergic''
 
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin ]] 30–60 mg/kg per day IV8–12 h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP-SMX]] 20 mg/kg/day q6–12h'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]]  8–12 g per day IV q4–6h '''''<BR> ''OR''<BR>▸''''[[Ceftriaxone]] 2 g IV q12 h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 mg IV q8h'''''
|-
|-
|}
| style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|N. meningitidis}}''
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:19em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Age 1—4 Weeks}}''
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 2 mg IV q12hx 7 days'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ▸ '''''If Ȕ-Lactam Allergic'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 150—200 mg/kg/day IV q6—8h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Chloro]] 12.5 mg/kg (up to 1 gm) IV q6h'''''
|-
|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Alternative Regimen''
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 gm IV q8h''''' <BR>''OR''<BR>'''''[[Moxifloxacin]] 400 mg q24h'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h'''''
 
| style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|E. coli, other coliforms, or P. aeruginosa}}''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
 
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q8h''''' <BR> OR <BR> ▸ '''''[[Tobramycin]]2.5 mg/kg IV q8h''''' <BR> OR <BR> ▸ '''''[[Amikacin]] 10 mg/kg IV q8h'''''
|-
|-


| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]]'''''2 gm IV q8h <BR>''OR''<BR>'''''[[cefepime]] 2 gm IV q8h'''''


|}
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:19em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Immunocompromised state}}''
|-
|-


| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS OR NOT''
|-


! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]]'''''
|-|}
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:32em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|S. pneumoniae}}''<sup>‡<sup>
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | '''''[[Vancomycin ]] 30–60 mg/kg per day IV 8–12 h'''''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Pen G MIC <0.1 mcg/mL  ''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin]] G 4 million units IV q4h'''''<BR>''OR''<BR>'''''[[Ampicillin]] 2 gm IV
q4h'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4 h '''''
! style="padding: 0 5px; font-size: 80%; background: #DCDCDC" align=left | ''Alternative Regimen''
 
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 2 gm IV q12h''''' <BR>''OR''<BR>
''''' [[Chloramphenicol]] 1 gm IV q6h'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Pen G MIC :0.1–1 mcg/mL''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8 h''''' <BR> ''OR'' <BR> '''''[[Meropenem]] 2 g IV q8 h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 2 gm IV q12h''''' <BR>''OR''<BR>'''''[[Cefotaxime]] 2 gm IV q4–6h'''''  
|-
|-
|}
! style="padding: 0 5px; font-size: 80%; background: #DCDCDC" align=left | ''Alternative Regimen''
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:19em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Age 1—23 Months}}''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 gm IV q8h'''''<BR>''OR''<BR>'''''[[Meropenem]] 2 gm IV q8h'''''


|-
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Pen G MIC :≥2 mcg/mL''


! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin ]] 15 mg/kg IV q6 h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 500–750 mg IV q6h'''''  
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 225–300 mg/kg per day IV q6–8 h''''' <BR>''OR''<BR>'''''[[Ceftriaxone]] 80–100 mg/kg per day IV q12–24 h'''''<sup>¤</sup>
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 2 gm IV q12h''''' <BR>''OR''<BR> '''''[[Cefotaxime]] 2 gm IV q4–6h'''''  
|-
|-
 
! style="padding: 0 5px; font-size: 80%; background: #DCDCDC" align=left | ''Alternative Regimen''
 
|}
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:19em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Recurrent}}''
|-
|-
 
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]]  400 mg IV q24h'''''
 
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin ]] 30–60 mg/kg per day IV8–12 h'''''
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''[[Ceftriaxone]] MIC ≥ 1mcg/mL'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 500–750 mg IV q6h'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | '''''[[Cefotaxime]]  8–12 g per day IVq4–6h '''''<BR> ''OR''<BR>▸''''[[Ceftriaxone]] 2 g IV q12 h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS''
|}
| valign=top |
{| style="margin: 0 0 0em 0em; border: 1px solid #696969; float: left; width:19em" cellpadding="0" cellspacing="0";
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Age 2–50 years}}''
|-
|-
 
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftriaxone]] 2 gm IV q12h''''' <BR>''OR''<BR> '''''[[Cefotaxime]] 2 gm IV q4–6h'''''  
 
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''Children's dosage is as shown left,shown below is the adult'''''
! style="padding: 0 5px; font-size: 80%; background: #DCDCDC" align=left | ''Alternative Regimen''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin ]] 30–60 mg/kg per day IV8–12 h'''''
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR>'''''If MIC to ceftriaxone >2 mcg/mL, add RIF 600 mg 1x/day'''''
|-
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | AND
|-
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]]  8–12 g per day IVq4–6h '''''<BR> ''OR''<BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12 h'''''<sup>¤</sup>
|-
|}
|}
|}
|}
<BR>
<SMALL><sup>¤</sup>Add amoxicillin or ampicillin if meningitis caused by L monocytogenes is also suspected. Ampicillin if meningitis caused by L monocytogenes is also suspected </SMALL>
====fhjdskjfkds====

Latest revision as of 23:45, 14 January 2014

H. Influenzae
Preferred Regimen
Ceftriaxone 50 mg/kg IV q12h
If Penicillin Allergic
Chloramphenicol 12.5 mg/kg IV q6h (max. 4 gm/day.)
Listeria Monocytogenes
Preferred Regimen
Ampicillin 50 mg/kg IV q12h 2mg iv q4h
PLUS OR NOT
gentamicin 2 mg/kg loading dose then 1.7kg/mg q8h
If Penicillin Allergic
TMP-SMX 20 mg/kg/day q6–12h
Alternative Regimen
Meropenem 2 mg IV q8h
N. meningitidis
Preferred Regimen
Ceftriaxone 2 mg IV q12hx 7 days
If Ȕ-Lactam Allergic
Chloro 12.5 mg/kg (up to 1 gm) IV q6h
Alternative Regimen
Meropenem 2 gm IV q8h
OR
Moxifloxacin 400 mg q24h
E. coli, other coliforms, or P. aeruginosa
Preferred Regimen
Ceftazidime2 gm IV q8h
OR
cefepime 2 gm IV q8h
PLUS OR NOT
Gentamicin
S. pneumoniae
Pen G MIC <0.1 mcg/mL
Penicillin G 4 million units IV q4h
OR
Ampicillin 2 gm IV

q4h

Alternative Regimen
Ceftriaxone 2 gm IV q12h
OR

Chloramphenicol 1 gm IV q6h

Pen G MIC :0.1–1 mcg/mL
Ceftriaxone 2 gm IV q12h
OR
Cefotaxime 2 gm IV q4–6h
Alternative Regimen
Cefepime 2 gm IV q8h
OR
Meropenem 2 gm IV q8h
Pen G MIC :≥2 mcg/mL
Vancomycin 500–750 mg IV q6h
PLUS
Ceftriaxone 2 gm IV q12h
OR
Cefotaxime 2 gm IV q4–6h
Alternative Regimen
Moxifloxacin 400 mg IV q24h
Ceftriaxone MIC ≥ 1mcg/mL
Vancomycin 500–750 mg IV q6h
PLUS
Ceftriaxone 2 gm IV q12h
OR
Cefotaxime 2 gm IV q4–6h
Alternative Regimen
Moxifloxacin 400 mg IV q24h
If MIC to ceftriaxone >2 mcg/mL, add RIF 600 mg 1x/day