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===Meningitis, bacteria===
* Bacterial meningitis<ref>{{Cite journal| doi = 10.1086/425368| issn = 1537-6591| volume = 39| issue = 9| pages = 1267–1284| last1 = Tunkel| first1 = Allan R.| last2 = Hartman| first2 = Barry J.| last3 = Kaplan| first3 = Sheldon L.| last4 = Kaufman| first4 = Bruce A.| last5 = Roos| first5 = Karen L.| last6 = Scheld| first6 = W. Michael| last7 = Whitley| first7 = Richard J.| title = Practice guidelines for the management of bacterial meningitis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2004-11-01| pmid = 15494903}}</ref>
 
:* Empiric antimicrobial therapy based on specific predisposing factors
::* Age
:::* '''Age &lt; 1 month'''
::::* Common causative pathogens: Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, Klebsiella species
::::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}} ([[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Amikacin]] 15 mg/kg/day IV q8h {{or}} [[Gentamicin]] 5 mg/kg/day IV q8h {{or}} [[Tobramycin]] 5 mg/kg/day IV q8h)
 
:::* '''Age 1–23 months'''
::::* Common causative pathogens: Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenzae, E. coli
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} ([[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h)
 
:::* '''Age 2–50 years'''
::::* Common causative pathogens: N . meningitidis, S. pneumoniae
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} ([[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h)
 
:::* '''Age &gt; 50 years'''
::::* Common causative pathogens: S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic Gram-negative bacilli
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Ampicillin]] 12 g/day IV q4h {{and}} ([[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h)
 
::* Head trauma
:::* '''Basilar skull fracture'''
::::* Common causative pathogens: S. pneumoniae, H. influenzae, group A β-hemolytic streptococci
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} ([[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h)


* Bacterial meningitis<ref>{{Cite journal| doi = 10.1086/425368| issn = 1537-6591| volume = 39| issue = 9| pages = 1267–1284| last1 = Tunkel| first1 = Allan R.| last2 = Hartman| first2 = Barry J.| last3 = Kaplan| first3 = Sheldon L.| last4 = Kaufman| first4 = Bruce A.| last5 = Roos| first5 = Karen L.| last6 = Scheld| first6 = W. Michael| last7 = Whitley| first7 = Richard J.| title = Practice guidelines for the management of bacterial meningitis| journal = Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America| date = 2004-11-01| pmid = 15494903}}</ref>
:::* '''Penetrating trauma'''
::::* Common causative pathogens: Staphylococcus aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic Gram-negative bacilli (including Pseudomonas aeruginosa)
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Cefepime]] 6 g/day IV q8h {{or}} [[Ceftazidime]] 6 g/day IV q8h {{or}} [[Meropenem]] 6 g/day IV q8h
 
::* '''Postneurosurgery'''
:::* Common causative pathogens: Aerobic Gram-negative bacilli (including P. aeruginosa), S. aureus, coagulase-negative staphylococci (especially S. epidermidis)
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Cefepime]] 6 g/day IV q8h {{or}} [[Ceftazidime]] 6 g/day IV q8h {{or}} [[Meropenem]] 6 g/day IV q8h
 
::* '''CSF shunt'''
:::* Common causative pathogens: Coagulase-negative staphylococci (especially S. epidermidis), S. aureus, aerobic Gram-negative bacilli (including P. aeruginosa), Propionibacterium acnes
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Cefepime]] 6 g/day IV q8h {{or}} [[Ceftazidime]] 6 g/day IV q8h {{or}} [[Meropenem]] 6 g/day IV q8h


:* CSF Gram stain-directed antimicrobial therapy
:* CSF Gram stain-directed antimicrobial therapy
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:::* Alternative regimen: [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}} [[Meropenem]] 6 g/day IV q8h
:::* Alternative regimen: [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}} [[Meropenem]] 6 g/day IV q8h


::* Streptococcus agalactiae
::* '''Gram positive cocci in short chains suggestive of Streptococcus agalactiae'''
:::* Preferred regimen: ([[Ampicillin]] 12 g/day IV q4h {{or}} [[Penicillin G]] 24 MU/day IV q4h) {{withorwithout}} ([[Amikacin]] 15 mg/kg/day IV q8h {{or}} [[Gentamicin]] 5 mg/kg/day IV q8h {{or}} [[Tobramycin]] 5 mg/kg/day IV q8h)
:::* Preferred regimen: ([[Ampicillin]] 12 g/day IV q4h {{or}} [[Penicillin G]] 24 MU/day IV q4h) {{withorwithout}} ([[Amikacin]] 15 mg/kg/day IV q8h {{or}} [[Gentamicin]] 5 mg/kg/day IV q8h {{or}} [[Tobramycin]] 5 mg/kg/day IV q8h)
:::* Alternative regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
:::* Alternative regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h


::* Haemophilus influenzae
::* '''Gram negative coccobacilli suggestive of Haemophilus influenzae'''
:::* Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
:::* Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
:::* Alternative regimen: [[Chloramphenicol]] 4–6 g/day IV q6h {{or}} [[Cefepime]] 6 g/day IV q8h {{or}} [[Meropenem]] 6 g/day IV q8h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h
:::* Alternative regimen: [[Chloramphenicol]] 4–6 g/day IV q6h {{or}} [[Cefepime]] 6 g/day IV q8h {{or}} [[Meropenem]] 6 g/day IV q8h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h


::* Escherichia coli
::* '''Gram negative bacilli suggestive of Escherichia coli'''
:::* Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
:::* Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
:::* Alternative regimen: [[Cefepime]] 6 g/day IV q8h {{or}} [[Meropenem]] 6 g/day IV q8h {{or}} [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h {{or}} [[Trimethoprim-Sulfamethoxazole]]
:::* Alternative regimen: [[Cefepime]] 6 g/day IV q8h {{or}} [[Meropenem]] 6 g/day IV q8h {{or}} [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h {{or}} [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h


:* Pathogen-directed antimicrobial therapy
:* Pathogen-directed antimicrobial therapy
::* Streptococcus pneumoniae (adult)
::* '''Streptococcus pneumoniae'''
:::* Penicillin MIC
:::* Penicillin MIC < 0.1 μg/mL
::::* <0.1 μg/mL
::::* Preferred regimen: [[Penicillin G]] 24 MU/day IV q4h {{or}} [[Ampicillin]] 12 g/day IV q4h
:::::* Preferred regimen: [[Penicillin G]] 24 mU 6 times per day {{or}} [[ampicillin]] 12g 6 times per day
::::* Alternative regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Chloramphenicol]] 4–6 g/day IV q6h
:::::* Alternative regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day {{or}} [[chloramphenicol]] 4-6g qid
::::* 0.1–1.0 μg/mL
:::::* Preferred regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day
:::::* Alternative regimen: [[Cefepime]] 6g tid {{or}} [[meropenem]] 6g tid
::::* ≥2.0 μg/mL
:::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg tid/bid {{and}} [[Ceftriaxone]] 4g bid/OD {{or}} [[Vancomycin]] 30–45 mg/kg tid/bid {{and}} [[cefotaxime]] 8-12g 4-6 times per day
:::::* Alternative regimen: [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
:::* Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL
:::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg tid/bid {{and}} [[Ceftriaxone]] 4g bid/OD {{or}} [[Vancomycin]] 30–45 mg/kg tid/bid {{and}} [[cefotaxime]] 8-12g 4-6 times per day
:::::* Alternative regimen: [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD


::* Streptococcus pneumoniae (pediatric)
:::* Penicillin MIC 0.1–1.0 μg/mL
:::* Penicillin MIC
::::* Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
::::* <0.1 μg/mL
::::* Alternative regimen: [[Cefepime]] 6 g/day IV q8h {{or}} [[Meropenem]] 6 g/day IV q8h
:::::* Preferred regimen: [[Penicillin G]] 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates;  0.3 mU/kg 4-6 times per day for children {{or}} [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
:::::* Alternative regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children {{or}} [[chloramphenicol]]  25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children
::::* 0.1–1.0 μg/mL
:::::* Preferred regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
:::::* Alternative regimen: [[Cefepime]] 150 mg/kg tid for children {{or}} [[meropenem]] 120 mg/kg tid for children
::::* ≥2.0 μg/mL
:::::* Preferred regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{and}} [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{and}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
:::::* Alternative regimen: [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
:::* Cefotaxime or ceftriaxone MIC ≥1.0 μg/mL
:::::* Preferred regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{and}} [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{and}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
:::::* Alternative regimen: [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD


::* Neisseria meningitidis (adult)
:::* Penicillin MIC ≥ 2.0 μg/mL
:::* Penicillin MIC
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} ([[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h)
::::* <0.1 μg/mL
::::* Alternative regimen: [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h
:::::* Preferred regimen: [[Penicillin G]] 24 mU 6 times per day {{or}} [[ampicillin]] 12g 6 times per day
:::::* Alternative regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day {{or}} [[chloramphenicol]] 4-6g qid
::::* 0.1–1.0 μg/mL
:::::* Preferred regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day
:::::* Alternative regimen: [[chloramphenicol]] 4-6g qid {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD  {{or}} [[meropenem]] 6g tid


::* Neisseria meningitidis (pediatric)
:::* Cefotaxime or ceftriaxone MIC ≥ 1.0 μg/mL
:::* Penicillin MIC
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} ([[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h)
::::* <0.1 μg/mL
::::* Alternative regimen: [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h
:::::* Preferred regimen: [[Penicillin G]] 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates;  0.3 mU/kg 4-6 times per day for children {{or}} [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
:::::* Alternative regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
::::* 0.1–1.0 μg/mL
:::::* Preferred regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
:::::* Alternative regimen: [[chloramphenicol]]  25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD  {{or}} [[meropenem]] 120 mg/kg tid for children


::* Listeria monocytogenes (adult)
::* '''Neisseria meningitidis'''
:::* Preferred regimen: [[Penicillin G]] 24 mU 6 times per day {{or}} [[ampicillin]] 12g 6 times per day
:::* Penicillin MIC &lt; 0.1 μg/mL
:::* Alternative regimen: [[Trimethoprim-sulfamethoxazole]] 10–20 mg/kg bid-qid {{or]} [[meropenem]] 6g tid
:::::* Preferred regimen: [[Penicillin G]] 24 MU/day IV q4h {{or}} [[Ampicillin]] 12 g/day IV q4h
:::::* Alternative regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Chloramphenicol]] 4–6 g/day IV q6h


::* Listeria monocytogenes (pediatric)
:::* Penicillin MIC 0.1–1.0 μg/mL
:::* Preferred regimen: [[Penicillin G]] 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates;  0.3 mU/kg 4-6 times per day for children {{or}} [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
:::::* Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
:::* Alternative regimen: [[Trimethoprim-sulfamethoxazole]]10–20 mg/kg bid-qid for children {{or]} [[meropenem]] 120 mg/kg tid for children
:::::* Alternative regimen: [[Chloramphenicol]] 4–6 g/day IV q6h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h {{or}} [[Meropenem]] 6 g/day IV q8h


::* Streptococcus agalactiae (adult)
::* '''Listeria monocytogenes'''
:::* Preferred regimen: [[Penicillin G]] 24 mU 6 times per day {{or}} [[ampicillin]] 12g 6 times per day
:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{or}} [[Penicillin G]] 24 MU/day IV q4h
:::* Alternative regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day
:::* Alternative regimen: [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}} [[Meropenem]] 6 g/day IV q8h


::* Streptococcus agalactiae (pediatric)
::* '''Streptococcus agalactiae'''
:::* Preferred regimen: [[Penicillin G]] 0.15 mU/kg tid/bid for 0-7 days neonates; 0.2 mU/kg tid/qid for 8-28 days neonates;  0.3 mU/kg 4-6 times per day for children {{or}} [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{or}} [[Penicillin G]] 24 MU/day IV q4h
:::* Alternative regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
:::* Alternative regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h


::* Escherichia coli and other Enterobacteriaceae (adult)
::* '''Escherichia coli and other Enterobacteriaceae'''
:::* Preferred regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day
:::* Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
:::* Alternative regimen: [[Aztreonam]] 6–8 g tid/qid {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD {{or}} [[meropenem]] 6g tid {{or}} [[Trimethoprim-sulfamethoxazole]] 10–20 mg/kg bid-qid {{or]} [[ampicillin]] 12g 6 times per day
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h {{or}} [[Meropenem]] 6 g/day IV q8h {{or}}  [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}} [[Ampicillin]] 12 g/day IV q4h
 
::* Escherichia coli and other Enterobacteriaceae (pediatric)
:::* Preferred regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 225–300 mg/kg tid/qid for children
:::* Alternative regimen: [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD {{or}} [[meropenem]] 120 mg/kg tid for children {{or}} [[Trimethoprim-sulfamethoxazole]]10–20 mg/kg bid-qid for children {{or}} [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
 
::* Pseudomonas aeruginosa (adult)
:::* Preferred regimen: [[Cefepime]] 6g tid {{or}} [[ceftazidime]] 6g tid
:::* Alternative regimen: [[Aztreonam]] 6–8 g tid/qid {{or}} [[ciprofloxacin]] 800–1200 mg bid/tid {or}} [[meropenem]] 6g tid
 
::* Pseudomonas aeruginosa (pediatric)
:::* Preferred regimen: [[Cefepime]] 150 mg/kg tid for children {{or}} [[ceftazidime]]  100–150 mg/kg tid/bid for 0-7 days neonates; 150 mg/kg tid for 8-28 days neonates; 150 mg/kg tid for children
:::* Alternative regimen: [[meropenem]] 120 mg/kg tid for children


::* Haemophilus influenzae (adult)
::* '''Pseudomonas aeruginosa'''
:::* β-Lactamase negative
:::* Preferred regimen: [[Cefepime]] 6 g/day IV q8h {{or}} [[Ceftazidime]] 6 g/day IV q8h
::::* Preferred regimen: [[ampicillin]] 12g 6 times per day
:::* Alternative regimen: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Ciprofloxacin]] 800–1200 mg IV q8–12h {{or}} [[Meropenem]] 6 g/day IV q8h
::::* Alternative regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day {{or}} [[Cefepime]] 6g tid {{or}} [[chloramphenicol]] 4-6g qid {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
:::* β-Lactamase positive
::::* Preferred regimen: [[Ceftriaxone]] 4g bid/OD {{or}} [[cefotaxime]] 8-12g 4-6 times per day  
::::* Alternative regimen: [[Cefepime]] 6g tid {{or}} [[chloramphenicol]] 4-6g qid {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD


::* Haemophilus influenzae (pediatric)
::* '''Haemophilus influenzae'''
:::* β-Lactamase negative
:::* β-Lactamase negative
::::* Preferred regimen:[[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children
::::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h
::::* Alternative regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children {{or}} [[Cefepime]] 150 mg/kg tid for children {{or}} [[chloramphenicol]] 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
::::* Alternative regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Cefepime]] 6 g/day IV q8h {{or}} [[Chloramphenicol]] 4–6 g/day IV q6h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h
:::* β-Lactamase positive
:::* β-Lactamase positive
::::* Preferred regimen: [[Ceftriaxone]] 80–100 mg/kg bid/OD for children {{or}} [[cefotaxime]] 100–150 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates;  225–300 mg/kg tid/qid for children
::::* Preferred regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h
::::* Alternative regimen: [[Cefepime]] 150 mg/kg tid for children {{or}} [[chloramphenicol]] 25 mg/kg OD for 0-7 days neonates; 50 mg/kg bid/OD for 8-28 days neonates; 75–100 mg/kg qid for children {{or}} [[Gatifloxacin]] 400 mg OD {{or}} [[moxifloxacin]] 400 mg OD
::::* Alternative regimen: [[Cefepime]] 6 g/day IV q8h {{or}} [[Chloramphenicol]] 4–6 g/day IV q6h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h


::* Staphylococcus aureus (adult)
::* '''Staphylococcus aureus'''
:::* Methicillin susceptible
:::* Methicillin susceptible
::::* Preferred regimen: [[Nafcillin]] 9–12 g 6 times per day {{or}} [[oxacillin]] 9–12 g 6 times per day
::::* Preferred regimen: [[Nafcillin]] 9–12 g/day IV q4h {{or}} [[Oxacillin]] 9–12 g/day IV q4h
::::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg tid/bid {{or}} [[meropenem]] 6g tid
::::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{or}} [[Meropenem]] 6 g/day IV q8h
:::* Methicillin resistant
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg tid/bid
::::* Alternative regimen: [[Trimethoprim-sulfamethoxazole]] 10–20 mg/kg bid-qid {{or}} [[linezolid]]


::* Staphylococcus aureus (pediatric)
:::* Methicillin susceptible
::::* Preferred regimen: [[Nafcillin]] 75 mg/kg bid/tid for 0-7 days neonates;  100–150 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children {{or}} [[oxacillin]] 75 mg/kg bid/tid for 0-7 days neonates; 150–200 mg/kg tid/qid for 8-28 days neonates; 200 mg/kg qid for children
::::* Alternative regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{or}} [[meropenem]] 120 mg/kg tid for children
:::* Methicillin resistant
:::* Methicillin resistant
::::* Preferred regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
::::* Alternative regimen: [[Trimethoprim-sulfamethoxazole]] 10–20 mg/kg bid-qid for children {{or}} [[linezolid]]
::::* Alternative regimen: [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}} [[Linezolid]] 600 mg IV q12h


::* Staphylococcus epidermidis (adult)
::* '''Staphylococcus epidermidis'''
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg tid/bid
:::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
:::* Alternative regimen: [[Linezolid]]
:::* Alternative regimen: [[Linezolid]] 600 mg IV q12h


::* Staphylococcus epidermidis (pediatric)
::* '''Enterococcus species'''
:::* Preferred regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children
:::* Ampicillin susceptible
:::* Alternative regimen: [[Linezolid]]
::::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}}  [[Gentamicin]] 5 mg/kg/day IV q8h


::* Enterococcus species (adult)
:::* Ampicillin susceptible
::::* Preferred regimen:  [[ampicillin]] 12g 6 times per day {{and}} [[gentamicin]] 5 mg/kg tid
:::* Ampicillin resistant
:::* Ampicillin resistant
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg tid/bid {{and}} [[gentamicin]] 5 mg/kg tid
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}} [[Gentamicin]] 5 mg/kg/day IV q8h
 
:::* Ampicillin and vancomycin resistant
:::* Ampicillin and vancomycin resistant
::::* Preferred regimen: [[Linezolid]]
::::* Preferred regimen: [[Linezolid]] 600 mg IV q12h
 
:* Pediatric dose:
::* [[Amikacin]]
:::* Neonates age 0–7 days: 15–20 mg/kg/day q12h
:::* Neonates age 8–28 days: 30 mg/kg/day q8h
:::* Infants and children: 20–30 mg/kg/day q8h
 
::* [[Ampicillin]]
:::* Neonates age 0–7 days: 150 mg/kg/day q8h
:::* Neonates age 8–28 days: 200 mg/kg/day q6–8h
:::* Infants and children: 300 mg/kg/day q6h
 
::* [[Cefepime]]
:::* Infants and children: 150 mg/kg/day q8h
 
::* [[Cefotaxime]]
:::* Neonates age 0–7 days: 100–150 mg/kg/day q8–12h
:::* Neonates age 8–28 days: 150–200 mg/kg/day q6–8h
:::* Infants and children: 225–300 mg/kg/day q6–8h


::* Enterococcus species (pediatric)
::* [[Ceftazidime]]
:::* Ampicillin susceptible
:::* Neonates age 0–7 days: 100–150 mg/kg/day q8–12h
::::* Preferred regimen: [[ampicillin]] 150 mg/kg tid for 0-7 days neonates; 200 mg/kg tid/qid for 8-28 days neonates; 300 mg/kg qid for children {{and}} [[gentamicin]] 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children
:::* Neonates age 8–28 days: 150 mg/kg q8h
:::* Ampicillin resistant
:::* Infants and children: 150 mg/kg
::::* Preferred regimen: [[Vancomycin]] 20–30 mg/kg bid/tid for 0-7 days neonates; 30–45 mg/kg tid/qid for 8-28 days neonates; 60 mg/kg qid for children {{and}} [[gentamicin]] 5 mg/kg bid for 0-7 days neonates; 7.5 mg/kg tid for 8-28 days neonates; 7.5 mg/kg tid for children
 
:::* Ampicillin and vancomycin resistant
::* [[Ceftriaxone]]
::::* Preferred regimen:  [[Linezolid]]
:::* Infants and children: 80–100 mg/kg/day q12–24h
 
::* [[Chloramphenicol]]
:::* Neonates age 0–7 days: 25 mg/kg/day q24h
:::* Neonates age 8–28 days: 50 mg/kg/day q12–24h
:::* Infants and children: 75–100 mg/kg/day q6h
 
::* [[Gentamicin]]
:::* Neonates age 0–7 days: 5 mg/kg/day q12h
:::* Neonates age 8–28 days: 7.5 mg/kg/day q8h
:::* Infants and children: 7.5 mg/kg/day q8h
 
::* [[Meropenem]]
:::* Infants and children: 120 mg/kg/day q8h
 
::* [[Nafcillin]]
:::* Neonates age 0–7 days: 75 mg/kg/day q8–12h
:::* Neonates age 8–28 days: 100–150 mg/kg/day q6–8h
:::* Infants and children: 200 mg/kg/day q6h
 
::* [[Oxacillin]]
:::* Neonates age 0–7 days: 75 mg/kg/day q8–12h
:::* Neonates age 8–28 days: 150–200 mg/kg/day q6–8h
:::* Infants and children: 200 mg/kg/day q6h
 
::* [[Penicillin G]]
:::* Neonates age 0–7 days: 0.15 MU/kg/day q8–12h
:::* Neonates age 8–28 days: 0.2 MU/kg/day q6–8h
:::* Infants and children: 0.3 MU/kg/day q4–6h
 
::* [[Rifampin]]
:::* Neonates age 8–28 days: 10–20 mg/kg/day q12h
:::* Infants and children: 10–20 mg/kg/day q12–24h
 
::* [[Tobramycin]]
:::* Neonates age 0–7 days: 5 mg/kg/day q12h
:::* Neonates age 8–28 days: 7.5 mg/kg/day q8h
:::* Infants and children: 7.5 mg/kg/day q8h
 
::* [[Trimethoprim-Sulfamethoxazole]]
:::* Infants and children: 10–20 mg/kg q6–12h


==References==
::* [[Vancomycin]]
{{reflist|2}}
:::* Neonates age 0–7 days: 20–30 mg/kg/day q8–12h
:::* Neonates age 8–28 days: 30–45 mg/kg/day q6–8h
:::* Infants and children: 60 mg/kg/day q6h

Latest revision as of 22:41, 8 June 2015

  • Bacterial meningitis[1]
  • Empiric antimicrobial therapy based on specific predisposing factors
  • Age
  • Age < 1 month
  • Common causative pathogens: Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, Klebsiella species
  • Preferred regimen: Ampicillin 12 g/day IV q4h AND (Cefotaxime 8–12 g/day q4–6h OR Amikacin 15 mg/kg/day IV q8h OR Gentamicin 5 mg/kg/day IV q8h OR Tobramycin 5 mg/kg/day IV q8h)
  • Age 1–23 months
  • Common causative pathogens: Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenzae, E. coli
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
  • Age 2–50 years
  • Common causative pathogens: N . meningitidis, S. pneumoniae
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
  • Age > 50 years
  • Common causative pathogens: S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic Gram-negative bacilli
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Ampicillin 12 g/day IV q4h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
  • Head trauma
  • Basilar skull fracture
  • Common causative pathogens: S. pneumoniae, H. influenzae, group A β-hemolytic streptococci
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND (Ceftriaxone 4 g IV q12–24h OR Cefotaxime 8–12 g/day q4–6h)
  • Penetrating trauma
  • Common causative pathogens: Staphylococcus aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic Gram-negative bacilli (including Pseudomonas aeruginosa)
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
  • Postneurosurgery
  • Common causative pathogens: Aerobic Gram-negative bacilli (including P. aeruginosa), S. aureus, coagulase-negative staphylococci (especially S. epidermidis)
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
  • CSF shunt
  • Common causative pathogens: Coagulase-negative staphylococci (especially S. epidermidis), S. aureus, aerobic Gram-negative bacilli (including P. aeruginosa), Propionibacterium acnes
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h AND Cefepime 6 g/day IV q8h OR Ceftazidime 6 g/day IV q8h OR Meropenem 6 g/day IV q8h
  • CSF Gram stain-directed antimicrobial therapy
  • Gram positive, lancet-shaped diplococci suggestive of Streptococcus pneumoniae
  • Gram negative diplococci suggestive of Neisseria meningitidis
  • Gram positive, short bacilli suggestive of Listeria monocytogenes
  • Gram positive cocci in short chains suggestive of Streptococcus agalactiae
  • Gram negative coccobacilli suggestive of Haemophilus influenzae
  • Gram negative bacilli suggestive of Escherichia coli
  • Pathogen-directed antimicrobial therapy
  • Streptococcus pneumoniae
  • Penicillin MIC < 0.1 μg/mL
  • Penicillin MIC 0.1–1.0 μg/mL
  • Penicillin MIC ≥ 2.0 μg/mL
  • Cefotaxime or ceftriaxone MIC ≥ 1.0 μg/mL
  • Neisseria meningitidis
  • Penicillin MIC < 0.1 μg/mL
  • Penicillin MIC 0.1–1.0 μg/mL
  • Listeria monocytogenes
  • Streptococcus agalactiae
  • Escherichia coli and other Enterobacteriaceae
  • Pseudomonas aeruginosa
  • Haemophilus influenzae
  • β-Lactamase negative
  • β-Lactamase positive
  • Staphylococcus aureus
  • Methicillin susceptible
  • Methicillin resistant
  • Staphylococcus epidermidis
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
  • Alternative regimen: Linezolid 600 mg IV q12h
  • Enterococcus species
  • Ampicillin susceptible
  • Ampicillin resistant
  • Ampicillin and vancomycin resistant
  • Pediatric dose:
  • Neonates age 0–7 days: 15–20 mg/kg/day q12h
  • Neonates age 8–28 days: 30 mg/kg/day q8h
  • Infants and children: 20–30 mg/kg/day q8h
  • Neonates age 0–7 days: 150 mg/kg/day q8h
  • Neonates age 8–28 days: 200 mg/kg/day q6–8h
  • Infants and children: 300 mg/kg/day q6h
  • Infants and children: 150 mg/kg/day q8h
  • Neonates age 0–7 days: 100–150 mg/kg/day q8–12h
  • Neonates age 8–28 days: 150–200 mg/kg/day q6–8h
  • Infants and children: 225–300 mg/kg/day q6–8h
  • Neonates age 0–7 days: 100–150 mg/kg/day q8–12h
  • Neonates age 8–28 days: 150 mg/kg q8h
  • Infants and children: 150 mg/kg
  • Infants and children: 80–100 mg/kg/day q12–24h
  • Neonates age 0–7 days: 25 mg/kg/day q24h
  • Neonates age 8–28 days: 50 mg/kg/day q12–24h
  • Infants and children: 75–100 mg/kg/day q6h
  • Neonates age 0–7 days: 5 mg/kg/day q12h
  • Neonates age 8–28 days: 7.5 mg/kg/day q8h
  • Infants and children: 7.5 mg/kg/day q8h
  • Infants and children: 120 mg/kg/day q8h
  • Neonates age 0–7 days: 75 mg/kg/day q8–12h
  • Neonates age 8–28 days: 100–150 mg/kg/day q6–8h
  • Infants and children: 200 mg/kg/day q6h
  • Neonates age 0–7 days: 75 mg/kg/day q8–12h
  • Neonates age 8–28 days: 150–200 mg/kg/day q6–8h
  • Infants and children: 200 mg/kg/day q6h
  • Neonates age 0–7 days: 0.15 MU/kg/day q8–12h
  • Neonates age 8–28 days: 0.2 MU/kg/day q6–8h
  • Infants and children: 0.3 MU/kg/day q4–6h
  • Neonates age 8–28 days: 10–20 mg/kg/day q12h
  • Infants and children: 10–20 mg/kg/day q12–24h
  • Neonates age 0–7 days: 5 mg/kg/day q12h
  • Neonates age 8–28 days: 7.5 mg/kg/day q8h
  • Infants and children: 7.5 mg/kg/day q8h
  • Infants and children: 10–20 mg/kg q6–12h
  • Neonates age 0–7 days: 20–30 mg/kg/day q8–12h
  • Neonates age 8–28 days: 30–45 mg/kg/day q6–8h
  • Infants and children: 60 mg/kg/day q6h
  1. ↑ Tunkel, Allan R.; Hartman, Barry J.; Kaplan, Sheldon L.; Kaufman, Bruce A.; Roos, Karen L.; Scheld, W. Michael; Whitley, Richard J. (2004-11-01). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–1284. doi:10.1086/425368. ISSN 1537-6591. PMID 15494903.
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