View source for Meningitis medical therapy

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{{Meningitis}}

{{CMG}}; {{AE}} {{CZ}}, {{SS}}

==Overview==

Acute bacterial meningitis is a medical emergency; commence empiric treatment after obtaining blood and/or [[cerebrospinal fluid|cerebrospinal fluid (CSF)]] cultures if the possibility of bacterial meningitis becomes evident. Once a bacterial etiology has been identified on a [[CSF]] [[Gram stain]], treatment regimen should be optimized accordingly. Further modifications may be required after the culture and/or ''in vitro'' susceptibility results are available.  Neuroimaging (such as [[CT scan]] and [[MRI]]) or [[lumbar puncture]] must not delay antimicrobial therapy.

==Principles of Therapy for Bacterial Meningitis==

====Factors Determining Antimicrobial Activity====

* Factors determine the acitivity of antimicrobial agents include [[pharmacodynamics]], [[pharmacokinetics]], penetration into the CSF, and [[bactericidal]] activity within the CSF.<ref name="Andes-1999">{{Cite journal  | last1 = Andes | first1 = DR. | last2 = Craig | first2 = WA. | title = Pharmacokinetics and pharmacodynamics of antibiotics in meningitis. | journal = Infect Dis Clin North Am | volume = 13 | issue = 3 | pages = 595-618 | month = Sep | year = 1999 | doi =  | PMID = 10470557 }}</ref>

* [[Beta-lactam]]s, [[aminoglycoside]]s, [[glycopeptide]]s, [[linezolid]], and [[daptomycin]] are considered to have poor penetration into the CSF, while [[fluoroquinolone]]s, [[chloramphenicol]], [[aztreonam]], and [[tigecycline]] generally achieve [[MIC|minimum inhibitory concentration (MIC)]] in the CSF at standard dosage.<ref name="Nau-2010">{{Cite journal  | last1 = Nau | first1 = R. | last2 = Sörgel | first2 = F. | last3 = Eiffert | first3 = H. | title = Penetration of drugs through the blood-cerebrospinal fluid/blood-brain barrier for treatment of central nervous system infections. | journal = Clin Microbiol Rev | volume = 23 | issue = 4 | pages = 858-83 | month = Oct | year = 2010 | doi = 10.1128/CMR.00007-10 | PMID = 20930076 }}</ref>

* [[Aminoglycoside]]s and [[fluoroquinolone]]s express a concentration-dependent manner of bactericidal activity; [[beta-lactam]]s typically follow a a time-dependent antimicrobial pattern (i.e., the activity is dependent on the time that CSF concentration exceeds [[MIC]] as a proportion of the dosing interval).

* Penetration into the CSF is less prominent for drugs with a high [[molecular weight]], high protein-binding ability, low lipid solubility, and drugs that are subject to [[active transport]] in the [[choroid plexus]] such as [[penicillin]]s and [[cephalosporin]]s. Toxicity due to dose escalation may limit the usage the [[aminoglycoside]]s, [[glycopeptide]]s, and [[polymyxin]]s, thus [[intrathecal]] or [[intraventricular]] administration might be occasionally required (see table below).


{| style="border: 2px solid #696969;" align="center"
|+ <SMALL>''Recommended Doses of Antimicrobial Agents via the Intraventricular Route.''<ref name="van de Beek-2010">{{Cite journal  | last1 = van de Beek | first1 = D. | last2 = Drake | first2 = JM. | last3 = Tunkel | first3 = AR. | title = Nosocomial bacterial meningitis. | journal = N Engl J Med | volume = 362 | issue = 2 | pages = 146-54 | month = Jan | year = 2010 | doi = 10.1056/NEJMra0804573 | PMID = 20071704 }}</ref><ref name="Rodríguez Guardado-2008">{{Cite journal  | last1 = Rodríguez Guardado | first1 = A. | last2 = Blanco | first2 = A. | last3 = Asensi | first3 = V. | last4 = Pérez | first4 = F. | last5 = Rial | first5 = JC. | last6 = Pintado | first6 = V. | last7 = Bustillo | first7 = E. | last8 = Lantero | first8 = M. | last9 = Tenza | first9 = E. | title = Multidrug-resistant Acinetobacter meningitis in neurosurgical patients with intraventricular catheters: assessment of different treatments. | journal = J Antimicrob Chemother | volume = 61 | issue = 4 | pages = 908-13 | month = Apr | year = 2008 | doi = 10.1093/jac/dkn018 | PMID = 18281693 }}</ref><ref name="Cruciani-1992">{{Cite journal  | last1 = Cruciani | first1 = M. | last2 = Navarra | first2 = A. | last3 = Di Perri | first3 = G. | last4 = Andreoni | first4 = M. | last5 = Danzi | first5 = MC. | last6 = Concia | first6 = E. | last7 = Bassetti | first7 = D. | title = Evaluation of intraventricular teicoplanin for the treatment of neurosurgical shunt infections. | journal = Clin Infect Dis | volume = 15 | issue = 2 | pages = 285-9 | month = Aug | year = 1992 | doi =  | PMID = 1387805 }}</ref></SMALL>
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px"| '''Antimicrobial Agent''' || style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px" | '''Daily Intraventricular Dose'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Vancomycin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—20 mg'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Gentamicin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''4—8 mg'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Tobramycin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—20 mg'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Amikacin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—50 mg'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Polymyxin B]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5 mg'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Colistin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''10 mg'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Quinupristin dalfopristin|Quinupristin/Dalfopristin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''2—5 mg'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Teicoplanin]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''5—40 mg'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Amphotericin B]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''0.1—0.5 mg/day'''''
|-
|}


====Duration of Antimicrobial Therapy====

* The duration of therapy in patients with bacterial meningitis has not been well-supported by evidence-based data.

* The IDSA Practice Guideline provides recommendations on the duration of antimicrobial agents based on microorganisms (see table below). However, the duration of antimicrobial therapy should be individualized in accordance with patient's clinical response.

* Maximum [[parenteral]] dosage should be maintained throughout the recommended duration of therapy to ensure adequate bactericidal concentrations are attained since antimicrobial entry attenuates as [[meninges|meningeal]] inflammation subsides, especially when [[dexamethasone]] is co-administered.


{| style="border: 2px solid #696969;" align="center"
|+ <SMALL>''Recommended Duration of Antimicrobial Therapy Based on Isolated Pathogen.''<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref></SMALL>
| style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px"| '''''Microorganism''''' || style="background: #A5B2D6; border: 0px solid #696969; padding: 0 5px; width: 200px" | '''Duration of Therapy'''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Neisseria meningitidis]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''7 days'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Haemophilus influenzae]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''7 days'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Streptococcus pneumoniae]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''10—14 days'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Streptococcus agalactiae]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''14—21 days'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Gram-negative bacteria|Aerobic Gram-negative bacilli]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left |  '''''21 days'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #F5F5F5" align=left |&nbsp;▸&nbsp;'''''[[Listeria monocytogenes]]''''' || style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | '''''≥21 days'''''
|-
|}


====Adjunctive Dexamethasone Therapy====

* Evidences for beneficial effects of [[dexamethasone]] are variable. In some studies, adjunctive use of dexamethasone for bacterial meningitis in selected groups are associated with an improved survival or prognosis.<ref name="Lebel-1988">{{Cite journal  | last1 = Lebel | first1 = MH. | last2 = Freij | first2 = BJ. | last3 = Syrogiannopoulos | first3 = GA. | last4 = Chrane | first4 = DF. | last5 = Hoyt | first5 = MJ. | last6 = Stewart | first6 = SM. | last7 = Kennard | first7 = BD. | last8 = Olsen | first8 = KD. | last9 = McCracken | first9 = GH. | title = Dexamethasone therapy for bacterial meningitis. Results of two double-blind, placebo-controlled trials. | journal = N Engl J Med | volume = 319 | issue = 15 | pages = 964-71 | month = Oct | year = 1988 | doi = 10.1056/NEJM198810133191502 | PMID = 3047581 }}</ref><ref name="Odio-1991">{{Cite journal  | last1 = Odio | first1 = CM. | last2 = Faingezicht | first2 = I. | last3 = Paris | first3 = M. | last4 = Nassar | first4 = M. | last5 = Baltodano | first5 = A. | last6 = Rogers | first6 = J. | last7 = Sáez-Llorens | first7 = X. | last8 = Olsen | first8 = KD. | last9 = McCracken | first9 = GH. | title = The beneficial effects of early dexamethasone administration in infants and children with bacterial meningitis. | journal = N Engl J Med | volume = 324 | issue = 22 | pages = 1525-31 | month = May | year = 1991 | doi = 10.1056/NEJM199105303242201 | PMID = 2027357 }}</ref><ref name="Thwaites-2004">{{Cite journal  | last1 = Thwaites | first1 = GE. | last2 = Nguyen | first2 = DB. | last3 = Nguyen | first3 = HD. | last4 = Hoang | first4 = TQ. | last5 = Do | first5 = TT. | last6 = Nguyen | first6 = TC. | last7 = Nguyen | first7 = QH. | last8 = Nguyen | first8 = TT. | last9 = Nguyen | first9 = NH. | title = Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults. | journal = N Engl J Med | volume = 351 | issue = 17 | pages = 1741-51 | month = Oct | year = 2004 | doi = 10.1056/NEJMoa040573 | PMID = 15496623 }}</ref><ref name="Brouwer-2010">{{Cite journal  | last1 = Brouwer | first1 = MC. | last2 = Heckenberg | first2 = SG. | last3 = de Gans | first3 = J. | last4 = Spanjaard | first4 = L. | last5 = Reitsma | first5 = JB. | last6 = van de Beek | first6 = D. | title = Nationwide implementation of adjunctive dexamethasone therapy for pneumococcal meningitis. | journal = Neurology | volume = 75 | issue = 17 | pages = 1533-9 | month = Oct | year = 2010 | doi = 10.1212/WNL.0b013e3181f96297 | PMID = 20881273 }}</ref><ref name="Fritz-2012">{{Cite journal  | last1 = Fritz | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = van de Beek | first3 = D. | title = Dexamethasone and long-term survival in bacterial meningitis. | journal = Neurology | volume = 79 | issue = 22 | pages = 2177-9 | month = Nov | year = 2012 | doi = 10.1212/WNL.0b013e31827595f7 | PMID = 23152589 }}</ref><ref name="Peltola-2007">{{Cite journal  | last1 = Peltola | first1 = H. | last2 = Roine | first2 = I. | last3 = Fernández | first3 = J. | last4 = Zavala | first4 = I. | last5 = Ayala | first5 = SG. | last6 = Mata | first6 = AG. | last7 = Arbo | first7 = A. | last8 = Bologna | first8 = R. | last9 = Miño | first9 = G. | title = Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-controlled trial. | journal = Clin Infect Dis | volume = 45 | issue = 10 | pages = 1277-86 | month = Nov | year = 2007 | doi = 10.1086/522534 | PMID = 17968821 }}</ref> However, other studies fail to demonstrate a substantial reduction of death or neurological disability.<ref name="van de Beek-2010">{{Cite journal  | last1 = van de Beek | first1 = D. | last2 = Farrar | first2 = JJ. | last3 = de Gans | first3 = J. | last4 = Mai | first4 = NT. | last5 = Molyneux | first5 = EM. | last6 = Peltola | first6 = H. | last7 = Peto | first7 = TE. | last8 = Roine | first8 = I. | last9 = Scarborough | first9 = M. | title = Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. | journal = Lancet Neurol | volume = 9 | issue = 3 | pages = 254-63 | month = Mar | year = 2010 | doi = 10.1016/S1474-4422(10)70023-5 | PMID = 20138011 }}</ref><ref name="Peltola-2010">{{Cite journal  | last1 = Peltola | first1 = H. | last2 = Roine | first2 = I. | last3 = Fernández | first3 = J. | last4 = González Mata | first4 = A. | last5 = Zavala | first5 = I. | last6 = Gonzalez Ayala | first6 = S. | last7 = Arbo | first7 = A. | last8 = Bologna | first8 = R. | last9 = Goyo | first9 = J. | title = Hearing impairment in childhood bacterial meningitis is little relieved by dexamethasone or glycerol. | journal = Pediatrics | volume = 125 | issue = 1 | pages = e1-8 | month = Jan | year = 2010 | doi = 10.1542/peds.2009-0395 | PMID = 20008417 }}</ref><ref name="Nguyen-2007">{{Cite journal  | last1 = Nguyen | first1 = TH. | last2 = Tran | first2 = TH. | last3 = Thwaites | first3 = G. | last4 = Ly | first4 = VC. | last5 = Dinh | first5 = XS. | last6 = Ho Dang | first6 = TN. | last7 = Dang | first7 = QT. | last8 = Nguyen | first8 = DP. | last9 = Nguyen | first9 = HP. | title = Dexamethasone in Vietnamese adolescents and adults with bacterial meningitis. | journal = N Engl J Med | volume = 357 | issue = 24 | pages = 2431-40 | month = Dec | year = 2007 | doi = 10.1056/NEJMoa070852 | PMID = 18077808 }}</ref><ref name="Molyneux-2002">{{Cite journal  | last1 = Molyneux | first1 = EM. | last2 = Walsh | first2 = AL. | last3 = Forsyth | first3 = H. | last4 = Tembo | first4 = M. | last5 = Mwenechanya | first5 = J. | last6 = Kayira | first6 = K. | last7 = Bwanaisa | first7 = L. | last8 = Njobvu | first8 = A. | last9 = Rogerson | first9 = S. | title = Dexamethasone treatment in childhood bacterial meningitis in Malawi: a randomised controlled trial. | journal = Lancet | volume = 360 | issue = 9328 | pages = 211-8 | month = Jul | year = 2002 | doi =  | PMID = 12133656 }}</ref> The occurrence of delayed [[cerebral thrombosis]] with dexamethasone therapy has been reported.<ref name="Schut-2009">{{Cite journal  | last1 = Schut | first1 = ES. | last2 = Brouwer | first2 = MC. | last3 = de Gans | first3 = J. | last4 = Florquin | first4 = S. | last5 = Troost | first5 = D. | last6 = van de Beek | first6 = D. | title = Delayed cerebral thrombosis after initial good recovery from pneumococcal meningitis. | journal = Neurology | volume = 73 | issue = 23 | pages = 1988-95 | month = Dec | year = 2009 | doi = 10.1212/WNL.0b013e3181c55d2e | PMID = 19890068 }}</ref>

* '''In infants and children with ''[[Haemophilus influenzae]]'' type b meningitis''', the IDSA Practice Guideline supports the use of adjunctive '''''[[Dexamethasone]] at 0.15 mg/kg q6h for 2—4 days''''' with the first dose administered 10—20 minutes prior to, or at least concomitant with, the first antimicrobial dose.<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/15494903 15494903]</ref>

* '''In adults with suspected or proven ''[[Streptococcus pneumoniae]]'' meningitis''', the IDSA also recommends '''''[[Dexamethasone]] at 0.15 mg/kg q6h for 2—4 days''''' with the first dose administered 10—20 minutes prior to, or at least concomitant with, the first antimicrobial dose. Dexamethasone should only be continued if the [[CSF]] [[Gram stain]] reveals [[Gram-positive]] [[diplococci]], or if blood or CSF cultures are positive for ''[[Streptococcus pneumoniae|S. pneumoniae]]''. In this scenario, certain authorities advocate the addition of [[rifampin]] to the empirical combination of [[vancomycin]] plus a third-generation [[cephalosporin]] pending culture results and ''in vitro'' [[susceptibility testing]].<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/15494903 15494903]</ref><ref name="pmid16394301">van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16394301 Community-acquired bacterial meningitis in adults.] ''N Engl J Med'' 354 (1):44-53. [http://dx.doi.org/10.1056/NEJMra052116 DOI:10.1056/NEJMra052116] PMID: [http://pubmed.gov/16394301 16394301]</ref>

* [[Dexamethasone]] should not be given to patients who have already received animicrobial therapy because it is unlikely to improve clinical outcome.<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/15494903 15494903]</ref>


==Empiric Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Lancet. 2012;380(9854):1693-702.''<ref name="van de Beek-2012">{{Cite journal  | last1 = van de Beek | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = Thwaites | first3 = GE. | last4 = Tunkel | first4 = AR. | title = Advances in treatment of bacterial meningitis. | journal = Lancet | volume = 380 | issue = 9854 | pages = 1693-702 | month = Nov | year = 2012 | doi = 10.1016/S0140-6736(12)61186-6 | PMID = 23141618 }}</ref> and ''N Engl J Med. 2010;362(2):146-54.''<ref name="van de Beek-2010">{{Cite journal  | last1 = van de Beek | first1 = D. | last2 = Drake | first2 = JM. | last3 = Tunkel | first3 = AR. | title = Nosocomial bacterial meningitis. | journal = N Engl J Med | volume = 362 | issue = 2 | pages = 146-54 | month = Jan | year = 2010 | doi = 10.1056/NEJMra0804573 | PMID = 20071704 }}</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==

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'''Community-Acquired'''
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&nbsp;&nbsp;▸&nbsp;&nbsp;'''Newborns, Age <1 Week'''
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&nbsp;&nbsp;▸&nbsp;&nbsp;'''Newborns, Age 1—4 Weeks'''
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&nbsp;&nbsp;▸&nbsp;&nbsp;'''Infants & Children'''
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&nbsp;&nbsp;▸&nbsp;&nbsp;'''Adults, Age <50 Years'''
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&nbsp;&nbsp;▸&nbsp;&nbsp;'''Adults, Age >50 Years'''
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&nbsp;&nbsp;▸&nbsp;&nbsp;'''Immunocompromised'''
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&nbsp;&nbsp;▸&nbsp;&nbsp;'''Recurrent'''
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'''Nosocomial'''
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</div>

<div class="mw-customtoggle-table08" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Postneurosurgical Infection'''
</font>
</div>

<div class="mw-customtoggle-table09" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''CSF Shunt Infection'''
</font>
</div>

<div class="mw-customtoggle-table10" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Penetrating Trauma'''
</font>
</div>

<div class="mw-customtoggle-table11" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Basilar Skull Fracture'''
</font>
</div>

| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Newborns, Age <1 Week}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 50 mg/kg IV q8—12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Newborns, Age 1—4 Weeks}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 50 mg/kg IV q6—8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; 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'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Infants & Children}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 75 mg/kg IV q6—8h''''' <BR> OR <BR> ▸ '''''[[Ceftriaxone]] 80—100 mg/kg/day IV q12—24h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''<sup>†</sup>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Meropenem]] 40 mg/kg IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> Add '''''[[Ampicillin]] 75 mg/kg IV q6h''''' if suspecting ''[[Listeria monocytogenes]]''.</SMALL>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Adults, Age <50 Years}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''<sup>†</sup>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''<sup>†</sup>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=left | <SMALL><sup>†</sup> Add '''''[[Ampicillin]] 2 g IV q4h''''' if suspecting ''[[Listeria monocytogenes]]''.</SMALL>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Adults, Age >50 Years}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Immunocompromised}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Recurrent}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table08" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Postneurosurgical Infection}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table09" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|CSF Shunt Infection}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table10" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Penetrating Trauma}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table11" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Basilar Skull Fracture}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5;" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC;" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h'''''
|-
|}
|}
|}


==CSF Gram Stain-Based Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Lancet. 2012;380(9854):1693-702.''<ref name="van de Beek-2012">{{Cite journal  | last1 = van de Beek | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = Thwaites | first3 = GE. | last4 = Tunkel | first4 = AR. | title = Advances in treatment of bacterial meningitis. | journal = Lancet | volume = 380 | issue = 9854 | pages = 1693-702 | month = Nov | year = 2012 | doi = 10.1016/S0140-6736(12)61186-6 | PMID = 23141618 }}</ref> and ''Clin Infect Dis. 2004;39(9):1267-84.''<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==

{|
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Gram-Positive'''
</font>
</div>

<div class="mw-customtoggle-table12" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive Cocci in Chains'''
</font>
</div>

<div class="mw-customtoggle-table13" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive Cocci in Pairs'''
</font>
</div>

<div class="mw-customtoggle-table14" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Positive (Cocco-)Bacilli'''
</font>
</div>

<div style="border-radius: 0 0 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Gram-Negative'''
</font>
</div>

<div class="mw-customtoggle-table15" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Cocci in Pairs'''
</font>
</div>

<div class="mw-customtoggle-table16" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Coccobacilli'''
</font>
</div>

<div class="mw-customtoggle-table17" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''Gram-Negative Bacilli'''
</font>
</div>

| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table12" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Positive Cocci in Chains}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q8—12h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table13" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Positive Cocci in Pairs}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table14" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Positive (Cocco-)Bacilli}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table15" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Negative Cocci in Pairs}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table16" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Negative Coccobacilli}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table17" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|Gram-Negative Bacilli}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL>
|-
|}
|}
|}


==Pathogen-Based Therapy <SMALL><SMALL><SMALL><SMALL><SMALL>Adapted from ''Lancet. 2012;380(9854):1693-702.''<ref name="van de Beek-2012">{{Cite journal  | last1 = van de Beek | first1 = D. | last2 = Brouwer | first2 = MC. | last3 = Thwaites | first3 = GE. | last4 = Tunkel | first4 = AR. | title = Advances in treatment of bacterial meningitis. | journal = Lancet | volume = 380 | issue = 9854 | pages = 1693-702 | month = Nov | year = 2012 | doi = 10.1016/S0140-6736(12)61186-6 | PMID = 23141618 }}</ref> and ''Clin Infect Dis. 2004;39(9):1267-84.''<ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/1549490315494903]</ref></SMALL></SMALL></SMALL></SMALL></SMALL>==

{|
| valign=top |
<div style="border-radius: 5px 5px 0 0; border: solid 1px #20538D; border-bottom: 0px; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #A1BCDD; text-align: center;">
<font color="#FFF">
'''Bacteria'''
</font>
</div>

<div class="mw-customtoggle-table18" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Acinetobacter baumannii'''''
</font>
</div>

<div class="mw-customtoggle-table19" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Enterobacteriaceae'''''
</font>
</div>

<div class="mw-customtoggle-table20" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Haemophilus influenzae'''''
</font>
</div>

<div class="mw-customtoggle-table21" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Listeria monocytogenes'''''
</font>
</div>

<div class="mw-customtoggle-table22" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Neisseria meningitidis'''''
</font>
</div>

<div class="mw-customtoggle-table23" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Pseudomonas aeruginosa'''''
</font>
</div>

<div class="mw-customtoggle-table24" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Staphylococcus aureus'''''
</font>
</div>

<div class="mw-customtoggle-table25" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Staphylococcus epidermidis'''''
</font>
</div>

<div class="mw-customtoggle-table26" style="cursor: pointer; border-radius: 0 0 0 0; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Streptococcus agalactiae'''''
</font>
</div>

<div class="mw-customtoggle-table27" style="cursor: pointer; border-radius: 0 0 5px 5px; border: solid 1px #20538D; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5); box-shadow: inset 0 1px 1px rgba(255, 255, 255, 0.5), 0 1px 1px rgba(0, 0, 0, 0.5); height: 30px; line-height: 30px; width: 225px; background: #4479BA;">
<font color="#FFF">
&nbsp;&nbsp;▸&nbsp;&nbsp;'''''Streptococcus pneumoniae'''''
</font>
</div>

| valign=top |
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table18" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Acinetobacter baumannii''}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Colistin]] 1.25 mg/kg IV q6—12h'''''<BR> OR <BR> ▸ '''''[[Polymyxin B]] 0.75—1.25 mg/kg IV q12h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table19" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Enterobacteriaceae''}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table20" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''H. influenzae'', β-lactamase Negative}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''
|-
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''H. influenzae'', β-lactamase Positive}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''
|-
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''H. influenzae'', β-lactamase Negative, Ampicillin Resistant}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table21" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Listeria monocytogenes''}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table22" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''N. meningitidis'', Penicillin MIC <0.1 μg/mL}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''
|-
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''N. meningitidis'', Penicillin MIC ≥0.1 μg/mL}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''<BR> OR <BR> ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table23" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Pseudomonas aeruginosa''}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Cefepime]] 2 g IV q8h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Aztreonam]] 2 g IV q6—8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Ciprofloxacin]] 400 mg IV q8—12h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table24" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus aureus'', Methicillin sensitive}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Nafcillin]] 1.5—2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Oxacillin]] 1.5—2 g IV q4h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL><BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''
|-
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus aureus'', Methicillin resistant}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[TMP/SMZ]] 5 mg/kg IV q6—12h''''' <SMALL>(TMP component)</SMALL><BR> OR <BR> ▸ '''''[[Linezolid]] 600 mg IV q12h'''''<BR> OR <BR> ▸ '''''[[Daptomycin]] 6 mg/kg IV q24h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table25" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Staphylococcus epidermidis''}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Linezolid]] 600 mg IV q12h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h'''''
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table26" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''Streptococcus agalactiae''}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h'''''<BR> OR <BR> ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 1.7 mg/kg IV q8h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
|}
|}
{| class="mw-collapsible mw-collapsed" id="mw-customcollapsible-table27" style="background: #FFFFFF;"
| valign=top |
{| style="float: left; cellpadding=0; cellspacing= 0; width: 400px;"
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'', Penicillin MIC ≤0.06 μg/mL}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Penicillin G]] 4 MU IV q4h'''''<BR> OR <BR> ▸ '''''[[Ampicillin]] 2 g IV q4h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''<BR> OR <BR> ▸ '''''[[Chloramphenicol]] 1—1.5 g IV q6h'''''
|-
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'', Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC <1.0 μg/mL}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR> OR <BR> ▸ '''''[[Meropenem]] 2 g IV q8h'''''
|-
! style="height: 30px; line-height: 30px; background: #4479BA; border: 0px; font-size: 100%; text-shadow: 0 -1px 0 rgba(0, 0, 0, 0.5);" align=center | {{fontcolor|#FFF|''S. pneumoniae'', Penicillin MIC ≥0.12 μg/mL, Cefotaxime/Ceftriaxone MIC ≥1.0 μg/mL}}
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Preferred Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 2 g IV q4—6h'''''<BR> OR <BR> ▸ '''''[[Ceftriaxone]] 2 g IV q12h'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Rifampin]] 600 mg IV q24h'''''
|-
| style="padding: 0 5px; font-size: 90%; background: #F5F5F5" align=center | '''''Alternative Regimen'''''
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <SMALL>(trough 15—20 μg/mL)</SMALL>
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | PLUS
|-
| style="font-size: 90%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Moxifloxacin]] 400 mg IV q24h'''''
|-
|}
|}
|}


==References==

{{Reflist|2}}

[[Category:Wikinfect]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]
[[Category:Neurology]]
[[Category:Primary care]]