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{{Meningitis}}
{{Meningitis}}


{{CMG}}; '''Associate Editor(s)-In-Chief:'''  {{CZ}}
{{CMG}}; {{AE}} {{SS}}


==Medical Therapy==
==Medical Therapy==
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====Empiric Treatment====
====Empiric Treatment====


* Do not wait for the results of the [[CT scan]] and the [[lumbar puncture]]; empiric treatment should be started as soon as possible.
======Community-acquired meningitis======
* Blood cultures should be drawn before starting the [[antibiotic]] therapy, and then the antibiotic treatment should be changed once the blood culture results are out.
 
* Empiric antibiotic treatment should be started within 30 minutes after the patient presentation.
* In case of high suspicion of pneumococcal meningitis in adult patients, 0.15 mg/kg IV Q6H dexomethasone should be administered for 2 to 4 days.
** The first dose of dexomethasone is given along with or 20 minutes prior to starting the antibiotics treatment.


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Revision as of 17:47, 14 January 2014

Meningitis Main Page

Patient Information

Overview

Causes

Classification

Viral Meningitis
Bacterial Meningitis
Fungal Meningitis

Differential Diagnosis

Diagnosis

Treatment

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sheng Shi, M.D. [2]

Medical Therapy

Empiric Treatment

Community-acquired meningitis
Age <1 Week
Preferred Regimen
Ampicillin 50 mg/kg IV q8h
AND
Cefotaxime 100—150 mg/kg/day IV q8—12h
Alternative Regimen
Ampicillin 50 mg/kg IV q8h
AND
Gentamicin 2.5 mg/kg IV q12h


Age >50 years
Preferred Regimen
Vancomycin 30–60 mg/kg per day IV8–12 h
AND
Cefotaxime 8–12 g per day IV q4–6h
OR
▸'Ceftriaxone 2 g IV q12 h
Age 1—4 Weeks
Preferred Regimen
Ampicillin 200 mg/kg/day IV q6—8h
AND
Cefotaxime 150—200 mg/kg/day IV q6—8h
Alternative Regimen
Ampicillin 200 mg/kg/day IV q6—8h
AND
Gentamicin 2.5 mg/kg IV q8h
OR
Tobramycin2.5 mg/kg IV q8h
OR
Amikacin 10 mg/kg IV q8h
Immunocompromised state
Preferred Regimen
Vancomycin 30–60 mg/kg per day IV 8–12 h
AND
Ampicillin 2 g IV q4 h
AND
Cefepime 2 g IV q8 h
OR
Meropenem 2 g IV q8 h
Age 1—23 Months
Preferred Regimen
Vancomycin 15 mg/kg IV q6 h
AND
Cefotaxime 225–300 mg/kg per day IV q6–8 h
OR
Ceftriaxone 80–100 mg/kg per day IV q12–24 h¤
Recurrent
Preferred Regimen
Vancomycin 30–60 mg/kg per day IV8–12 h
AND
Cefotaxime 8–12 g per day IVq4–6h
OR
▸'Ceftriaxone 2 g IV q12 h
Age 2–50 years
Preferred Regimen
Children's dosage is as shown left,shown below is the adult
Vancomycin 30–60 mg/kg per day IV8–12 h
AND
Cefotaxime 8–12 g per day IVq4–6h
OR
Ceftriaxone 2 g IV q12 h¤


¤Add amoxicillin or ampicillin if meningitis caused by L monocytogenes is also suspected. Ampicillin if meningitis caused by L monocytogenes is also suspected

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