Template:ID-Bacterial meningitis: Difference between revisions

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* 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>
* 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
:*1. '''Empiric antimicrobial therapy based on specific predisposing factors'''
::* Age
::*1.1 '''Age'''
:::* '''Age &lt; 1 month'''
:::*1.1.1 '''Age &lt; 1 month'''
::::* Common causative pathogens: Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, Klebsiella species
::::* 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)
::::* 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'''
:::*1.1.2 '''Age 1–23 months'''
::::* Common causative pathogens: Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenzae, E. coli
::::* 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)
::::* 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'''
:::*1.1.3 '''Age 2–50 years'''
::::* Common causative pathogens: N . meningitidis, S. pneumoniae
::::* 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)
::::* 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'''
:::*1.1.4 '''Age &gt; 50 years'''
::::* Common causative pathogens: S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic Gram-negative bacilli
::::* 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)
::::* 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
::*1.2 '''Head trauma'''
:::* '''Basilar skull fracture'''
:::*1.2.1 '''Basilar skull fracture'''
::::* Common causative pathogens: S. pneumoniae, H. influenzae, group A β-hemolytic streptococci
::::* 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)
::::* 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'''
:::*1.2.2 '''Penetrating trauma'''
::::* Common causative pathogens: Staphylococcus aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic Gram-negative bacilli (including Pseudomonas aeruginosa)
::::* 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)
::::* 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'''
::*1.3 '''Postneurosurgery'''
:::* Common causative pathogens: Aerobic Gram-negative bacilli (including P. aeruginosa), S. aureus, coagulase-negative staphylococci (especially S. epidermidis)
:::* 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)
:::* 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'''
::*1.4 '''CSF shunt'''
:::* Common causative pathogens: Coagulase-negative staphylococci (especially S. epidermidis), S. aureus, aerobic Gram-negative bacilli (including P. aeruginosa), Propionibacterium acnes
:::* 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)
:::* 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
:*2. '''CSF Gram stain-directed antimicrobial therapy'''
::* '''Gram positive, lancet-shaped diplococci suggestive of Streptococcus pneumoniae'''
::*2.1 '''Gram positive, lancet-shaped diplococci suggestive of Streptococcus 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)
:::* 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)
:::* Alternative regimen: [[Meropenem]] 6 g/day IV q8h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h
:::* Alternative regimen: [[Meropenem]] 6 g/day IV q8h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h


::* '''Gram negative diplococci suggestive of Neisseria meningitidis'''
::*2.2 '''Gram negative diplococci suggestive of Neisseria meningitidis'''
:::* 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: [[Penicillin G]] 24 MU/day IV q4h {{or}} [[Ampicillin]] 12 g/day IV q4h {{or}} [[Chloramphenicol]] 4–6 g/day IV q6h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h {{or}} [[Aztreonam]] 6–8 g/day IV q6–8h
:::* Alternative regimen: [[Penicillin G]] 24 MU/day IV q4h {{or}} [[Ampicillin]] 12 g/day IV q4h {{or}} [[Chloramphenicol]] 4–6 g/day IV q6h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h {{or}} [[Aztreonam]] 6–8 g/day IV q6–8h


::* '''Gram positive, short bacilli suggestive of Listeria monocytogenes'''
::*2.3 '''Gram positive, short bacilli suggestive of Listeria monocytogenes'''
:::* 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: [[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


::* '''Gram positive cocci in short chains suggestive of Streptococcus agalactiae'''
::*2.4 '''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


::* '''Gram negative coccobacilli suggestive of Haemophilus influenzae'''
::*2.5 '''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


::* '''Gram negative bacilli suggestive of Escherichia coli'''
::*2.6 '''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]] 10–20 mg/kg/day q6–12h
:::* 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
:*3. '''Pathogen-directed antimicrobial therapy'''
::* '''Acinetobacter baumannii'''
::*3.1 '''Acinetobacter baumannii'''
:::* Preferred regimen: [[Meropenem]] 2 g IV q8h
:::* Preferred regimen: [[Meropenem]] 2 g IV q8h
:::* Alternative regimen: [[Colistin]] 1.25 mg/kg IV q6—12h {{or}} [[Polymyxin B]] 0.75—1.25 mg/kg IV q12h
:::* Alternative regimen: [[Colistin]] 1.25 mg/kg IV q6—12h {{or}} [[Polymyxin B]] 0.75—1.25 mg/kg IV q12h


::* '''Enterococcus species'''
::*3.2 '''Borrelia burgdorferi'''<ref name="Wormser-2006">{{Cite journal  | last1 = Wormser | first1 = GP. | last2 = Dattwyler | first2 = RJ. | last3 = Shapiro | first3 = ED. | last4 = Halperin | first4 = JJ. | last5 = Steere | first5 = AC. | last6 = Klempner | first6 = MS. | last7 = Krause | first7 = PJ. | last8 = Bakken | first8 = JS. | last9 = Strle | first9 = F. | title = The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America. | journal = Clin Infect Dis | volume = 43 | issue = 9 | pages = 1089-134 | month = Nov | year = 2006 | doi = 10.1086/508667 | PMID = 17029130 }}</ref>
:::* Ampicillin susceptible
:::* Preferred regimen: [[Ceftriaxone]] 2 g IV q24h for 10—28 days
:::* Alternative regimen: [[Cefotaxime]] 2 g IV q8h for 10—28 days {{or}} [[Penicillin G]] 3—4 MU IV q4h for 10—28 days {{or}} [[Doxycycline]] 100—200 mg PO q12h for 10—28 days
 
::*3.3 '''Enterococcus species'''
:::*3.3.1 '''Ampicillin susceptible'''
::::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}}  [[Gentamicin]] 5 mg/kg/day IV q8h
::::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{and}}  [[Gentamicin]] 5 mg/kg/day IV q8h


:::* Ampicillin resistant
:::*3.3.2 '''Ampicillin resistant'''
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}}  [[Gentamicin]] 5 mg/kg/day IV q8h
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{and}}  [[Gentamicin]] 5 mg/kg/day IV q8h


:::* Ampicillin and vancomycin resistant
:::*3.3.3 '''Ampicillin and vancomycin resistant'''
::::* Preferred regimen: [[Linezolid]] 600 mg IV q12h
::::* Preferred regimen: [[Linezolid]] 600 mg IV q12h


::* '''Escherichia coli and other Enterobacteriaceae'''
::*3.4 '''Escherichia coli and other Enterobacteriaceae'''
:::* 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: [[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
:::* 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


::* '''Haemophilus influenzae'''
::*3.5 '''Haemophilus influenzae'''
:::* β-Lactamase negative
:::*3.5.1 '''β-Lactamase negative'''
::::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h
::::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h
::::* 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
::::* 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
:::*3.5.2 '''β-Lactamase positive'''
::::* 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}} [[Chloramphenicol]] 4–6 g/day IV q6h {{or}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h
::::* 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


::* '''Listeria monocytogenes'''
::*3.6 '''Listeria monocytogenes'''
:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{or}} [[Penicillin G]] 24 MU/day IV q4h
:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{or}} [[Penicillin G]] 24 MU/day IV q4h
:::* 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


::* '''Mycobacterium tuberculosis'''
::*3.7 '''Mycobacterium tuberculosis'''
:::* '''First-line therapy (dosing information: <span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab3]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab4]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab5]</span>)'''
:::*3.7.1 '''First-line therapy (dosing information: <span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab3]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab4]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab5]</span>)'''
::::* [[Isoniazid]]
::::* [[Isoniazid]]
::::* [[Rifampin]]
::::* [[Rifampin]]
Line 100: Line 104:
::::* [[Ethambutol]]
::::* [[Ethambutol]]


:::* '''Second-line therapy (dosing information: <span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab3]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab4]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab5]</span>)'''
:::*3.7.2 '''Second-line therapy (dosing information: <span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab3]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab4]</span><span class="plainlinks">[http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5211a1.htm#tab5]</span>)'''
::::* [[Cycloserine]]
::::* [[Cycloserine]]
::::* [[Ethionamide]]
::::* [[Ethionamide]]
Line 112: Line 116:
::::* [[Gatifloxacin]]
::::* [[Gatifloxacin]]


:::* Tuberculous meningitis caused by susceptible Mycobacterium tuberculosis<ref>{{Cite journal| doi = 10.1164/rccm.167.4.603| issn = 1073-449X| volume = 167| issue = 4| pages = 603–662| last1 = Blumberg| first1 = Henry M.| last2 = Burman| first2 = William J.| last3 = Chaisson| first3 = Richard E.| last4 = Daley| first4 = Charles L.| last5 = Etkind| first5 = Sue C.| last6 = Friedman| first6 = Lloyd N.| last7 = Fujiwara| first7 = Paula| last8 = Grzemska| first8 = Malgosia| last9 = Hopewell| first9 = Philip C.| last10 = Iseman| first10 = Michael D.| last11 = Jasmer| first11 = Robert M.| last12 = Koppaka| first12 = Venkatarama| last13 = Menzies| first13 = Richard I.| last14 = O'Brien| first14 = Richard J.| last15 = Reves| first15 = Randall R.| last16 = Reichman| first16 = Lee B.| last17 = Simone| first17 = Patricia M.| last18 = Starke| first18 = Jeffrey R.| last19 = Vernon| first19 = Andrew A.| last20 = American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society| title = American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis| journal = American Journal of Respiratory and Critical Care Medicine| date = 2003-02-15| pmid = 12588714}}</ref><ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref><ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref><ref>{{Cite journal| issn = 1057-5987| volume = 52| issue = RR-11| pages = 1–77| last1 = American Thoracic Society| last2 = CDC| last3 = Infectious Diseases Society of America| title = Treatment of tuberculosis| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2003-06-20| pmid = 12836625}}</ref>
:::*3.7.3 '''Tuberculous meningitis caused by susceptible Mycobacterium tuberculosis'''<ref>{{Cite journal| doi = 10.1164/rccm.167.4.603| issn = 1073-449X| volume = 167| issue = 4| pages = 603–662| last1 = Blumberg| first1 = Henry M.| last2 = Burman| first2 = William J.| last3 = Chaisson| first3 = Richard E.| last4 = Daley| first4 = Charles L.| last5 = Etkind| first5 = Sue C.| last6 = Friedman| first6 = Lloyd N.| last7 = Fujiwara| first7 = Paula| last8 = Grzemska| first8 = Malgosia| last9 = Hopewell| first9 = Philip C.| last10 = Iseman| first10 = Michael D.| last11 = Jasmer| first11 = Robert M.| last12 = Koppaka| first12 = Venkatarama| last13 = Menzies| first13 = Richard I.| last14 = O'Brien| first14 = Richard J.| last15 = Reves| first15 = Randall R.| last16 = Reichman| first16 = Lee B.| last17 = Simone| first17 = Patricia M.| last18 = Starke| first18 = Jeffrey R.| last19 = Vernon| first19 = Andrew A.| last20 = American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society| title = American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis| journal = American Journal of Respiratory and Critical Care Medicine| date = 2003-02-15| pmid = 12588714}}</ref><ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref><ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref><ref>{{Cite journal| issn = 1057-5987| volume = 52| issue = RR-11| pages = 1–77| last1 = American Thoracic Society| last2 = CDC| last3 = Infectious Diseases Society of America| title = Treatment of tuberculosis| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2003-06-20| pmid = 12836625}}</ref>
::::* '''Intensive phase (adult)'''
::::*3.7.3.1 '''Intensive phase (adult)'''
:::::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 2 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months  
:::::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 2 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months  


::::* '''Continuation phase (adult)'''
::::*3.7.3.2 '''Continuation phase (adult)'''
:::::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 7–10 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 7–10 months
:::::* Preferred regimen: [[Isoniazid]] 5 mg/kg (max: 300 mg) for 7–10 months {{and}} [[Rifampin]] 10 mg/kg (max: 600 mg) for 7–10 months


::::* '''Intensive phase (pediatric)'''
::::*3.7.3.3 '''Intensive phase (pediatric)'''
:::::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 2 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months  
:::::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 2 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 2 months {{and}} [[Pyrazinamide]] 15–30 mg/kg (max: 2 g) for 2 months {{and}} [[Ethambutol]] 15–20 mg/kg (max: 1 g) for 2 months  


::::* '''Continuation phase (pediatric)'''
::::*3.7.3.3 '''Continuation phase (pediatric)'''
:::::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 7–10 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 7–10 months
:::::* Preferred regimen: [[Isoniazid]] 10–15 mg/kg (max: 300 mg) for 7–10 months {{and}} [[Rifampin]] 10–20 mg/kg (max: 600 mg) for 7–10 months
:::::: Note (1): World Health Organization guidelines recommend that Ethambutol should be replaced by Streptomycin in tuberculous meningitis.<ref>{{Cite book| edition = 4th| publisher = World Health Organization| isbn = 9789241547833| title = Treatment of Tuberculosis: Guidelines| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-06-08| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138748/| pmid = 23741786}}</ref>  Streptomycin is contraindicated in pregnancy.
:::::* Note (1): World Health Organization guidelines recommend that Ethambutol should be replaced by Streptomycin in tuberculous meningitis.<ref>{{Cite book| edition = 4th| publisher = World Health Organization| isbn = 9789241547833| title = Treatment of Tuberculosis: Guidelines| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-06-08| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138748/| pmid = 23741786}}</ref>  Streptomycin is contraindicated in pregnancy.
:::::: Note (2): A 9– to 12–month course of treatment is recommended for tuberculous meningitis.<ref>{{Cite book| edition = 4th| publisher = World Health Organization| isbn = 9789241547833| title = Treatment of Tuberculosis: Guidelines| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-06-08| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138748/| pmid = 23741786}}</ref><ref>{{Cite journal| issn = 1057-5987| volume = 52| issue = RR-11| pages = 1–77| last1 = American Thoracic Society| last2 = CDC| last3 = Infectious Diseases Society of America| title = Treatment of tuberculosis| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2003-06-20| pmid = 12836625}}</ref>
:::::* Note (2): A 9– to 12–month course of treatment is recommended for tuberculous meningitis.<ref>{{Cite book| edition = 4th| publisher = World Health Organization| isbn = 9789241547833| title = Treatment of Tuberculosis: Guidelines| location = Geneva| series = WHO Guidelines Approved by the Guidelines Review Committee| accessdate = 2015-06-08| date = 2010| url = http://www.ncbi.nlm.nih.gov/books/NBK138748/| pmid = 23741786}}</ref><ref>{{Cite journal| issn = 1057-5987| volume = 52| issue = RR-11| pages = 1–77| last1 = American Thoracic Society| last2 = CDC| last3 = Infectious Diseases Society of America| title = Treatment of tuberculosis| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2003-06-20| pmid = 12836625}}</ref>
:::::: Note (3): Adjuvant [[Dexamethasone]] 0.3–0.4 mg/kg/day (max: 24 mg) is recommended unless drug resistance is suspected.<ref>{{Cite journal| doi = 10.1056/NEJMoa040573| issn = 1533-4406| volume = 351| issue = 17| pages = 1741–1751| last1 = Thwaites| first1 = Guy E.| last2 = Nguyen| first2 = Duc Bang| last3 = Nguyen| first3 = Huy Dung| last4 = Hoang| first4 = Thi Quy| last5 = Do| first5 = Thi Tuong Oanh| last6 = Nguyen| first6 = Thi Cam Thoa| last7 = Nguyen| first7 = Quang Hien| last8 = Nguyen| first8 = Tri Thuc| last9 = Nguyen| first9 = Ngoc Hai| last10 = Nguyen| first10 = Thi Ngoc Lan| last11 = Nguyen| first11 = Ngoc Lan| last12 = Nguyen| first12 = Hong Duc| last13 = Vu| first13 = Ngoc Tuan| last14 = Cao| first14 = Huu Hiep| last15 = Tran| first15 = Thi Hong Chau| last16 = Pham| first16 = Phuong Mai| last17 = Nguyen| first17 = Thi Dung| last18 = Stepniewska| first18 = Kasia| last19 = White| first19 = Nicholas J.| last20 = Tran| first20 = Tinh Hien| last21 = Farrar| first21 = Jeremy J.| title = Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults| journal = The New England Journal of Medicine| date = 2004-10-21| pmid = 15496623}}</ref><ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
:::::: Note (3): Adjuvant [[Dexamethasone]] 0.3–0.4 mg/kg/day (max: 24 mg) is recommended unless drug resistance is suspected.<ref>{{Cite journal| doi = 10.1056/NEJMoa040573| issn = 1533-4406| volume = 351| issue = 17| pages = 1741–1751| last1 = Thwaites| first1 = Guy E.| last2 = Nguyen| first2 = Duc Bang| last3 = Nguyen| first3 = Huy Dung| last4 = Hoang| first4 = Thi Quy| last5 = Do| first5 = Thi Tuong Oanh| last6 = Nguyen| first6 = Thi Cam Thoa| last7 = Nguyen| first7 = Quang Hien| last8 = Nguyen| first8 = Tri Thuc| last9 = Nguyen| first9 = Ngoc Hai| last10 = Nguyen| first10 = Thi Ngoc Lan| last11 = Nguyen| first11 = Ngoc Lan| last12 = Nguyen| first12 = Hong Duc| last13 = Vu| first13 = Ngoc Tuan| last14 = Cao| first14 = Huu Hiep| last15 = Tran| first15 = Thi Hong Chau| last16 = Pham| first16 = Phuong Mai| last17 = Nguyen| first17 = Thi Dung| last18 = Stepniewska| first18 = Kasia| last19 = White| first19 = Nicholas J.| last20 = Tran| first20 = Tinh Hien| last21 = Farrar| first21 = Jeremy J.| title = Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults| journal = The New England Journal of Medicine| date = 2004-10-21| pmid = 15496623}}</ref><ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
:::::: Note (4): Liaise with microbiology laboratory about genotype testing for drug resistance if there is high risk for MDR-TB.<ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
:::::: Note (4): Liaise with microbiology laboratory about genotype testing for drug resistance if there is high risk for MDR-TB.<ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>


:::* Tuberculous meningitis caused by Mycobacterium tuberculosis resistant to isoniazid or rifampin
:::*3.7.4 '''Tuberculous meningitis caused by Mycobacterium tuberculosis resistant to isoniazid or rifampin'''
::::* '''Isoniazid monoresistance'''<ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
::::*3.7.4.1 '''Isoniazid monoresistance'''<ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
:::::* Substitute [[Fluoroquinolones]] for [[Isoniazid]] in intensive phase regimen.
:::::* Substitute [[Fluoroquinolones]] for [[Isoniazid]] in intensive phase regimen.
:::::* Continue treatment with [[Rifampin]], [[Pyrazinamide]], and [[Fluoroquinolone]] for 12 months.
:::::* Continue treatment with [[Rifampin]], [[Pyrazinamide]], and [[Fluoroquinolone]] for 12 months.


::::* '''Rifampin monoresistance'''<ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
::::*3.7.4.2 '''Rifampin monoresistance'''<ref>{{Cite journal| doi = 10.1016/j.jinf.2009.06.011| issn = 1532-2742| volume = 59| issue = 3| pages = 167–187| last1 = Thwaites| first1 = Guy| last2 = Fisher| first2 = Martin| last3 = Hemingway| first3 = Cheryl| last4 = Scott| first4 = Geoff| last5 = Solomon| first5 = Tom| last6 = Innes| first6 = John| last7 = British Infection Society| title = British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children| journal = The Journal of Infection| date = 2009-09| pmid = 19643501}}</ref>
:::::* Substitute [[Fluoroquinolones]] for [[Rifampin]] in intensive phase regimen.
:::::* Substitute [[Fluoroquinolones]] for [[Rifampin]] in intensive phase regimen.
:::::* Continue treatment with [[Isoniazid]], [[Pyrazinamide]], and [[Fluoroquinolone]] for 18 months.
:::::* Continue treatment with [[Isoniazid]], [[Pyrazinamide]], and [[Fluoroquinolone]] for 18 months.


::::* '''MDR-TB (resistant to Isoniazid and Rifampin)'''<ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref>
::::*3.7.4.3 '''MDR-TB (resistant to Isoniazid and Rifampin)'''<ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref>
:::::* MDR tuberculosis therapy should be considered if there is a history of prior tuberculosis treatment, contact with a patient with MDR tuberculosis, or a poor clinical response to first-line TB therapy within 2 weeks despite a firm diagnosis and an adequate adherence to treatment.
:::::* MDR tuberculosis therapy should be considered if there is a history of prior tuberculosis treatment, contact with a patient with MDR tuberculosis, or a poor clinical response to first-line TB therapy within 2 weeks despite a firm diagnosis and an adequate adherence to treatment.
:::::* Second-line agents such as [[Aminoglycosides]] penetrate the BBB only in the presence of inflamed meninges, and [[Fluoroquinolones]], while able to penetrate into the CNS, have lower CSF levels than in the serum or brain parenchyma.
:::::* Second-line agents such as [[Aminoglycosides]] penetrate the BBB only in the presence of inflamed meninges, and [[Fluoroquinolones]], while able to penetrate into the CNS, have lower CSF levels than in the serum or brain parenchyma.
:::::* Consult infectious disease specialist.
:::::* Consult infectious disease specialist.


::::* '''XDR-TB (resistant to Isoniazid, Rifampin, Fluoroquinolones, and either Capreomycin, Kanamycin, or Amikacin)'''<ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref>
::::*3.7.4.4 '''XDR-TB (resistant to Isoniazid, Rifampin, Fluoroquinolones, and either Capreomycin, Kanamycin, or Amikacin)'''<ref>{{Cite journal| doi = 10.1128/CMR.00042-07| issn = 1098-6618| volume = 21| issue = 2| pages = 243–261, table of contents| last1 = Rock| first1 = R. Bryan| last2 = Olin| first2 = Michael| last3 = Baker| first3 = Cristina A.| last4 = Molitor| first4 = Thomas W.| last5 = Peterson| first5 = Phillip K.| title = Central nervous system tuberculosis: pathogenesis and clinical aspects| journal = Clinical Microbiology Reviews| date = 2008-04| pmid = 18400795| pmc = PMC2292571}}</ref>
:::::* Consider [[Ethionamide]] or [[Cycloserine]] to build the treatment regimen.
:::::* Consider [[Ethionamide]] or [[Cycloserine]] to build the treatment regimen.
:::::* Consult infectious disease specialist.
:::::* Consult infectious disease specialist.


::* '''Neisseria meningitidis'''
::*3.8 '''Neisseria gonorrheoae'''<ref>{{Cite journal| issn = 1545–8601| volume = 59| issue = RR–12| pages = 1–110| last1 = Workowski| first1 = Kimberly A.| last2 = Berman| first2 = Stuart| last3 = Centers for Disease Control and Prevention (CDC)| title = Sexually transmitted diseases treatment guidelines, 2010| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2010–12–17| pmid = 21160459}}</ref><ref>{{Cite journal| issn = 1545–861X| volume = 61| issue = 31| pages = 590–594| last = Centers for Disease Control and Prevention (CDC)| title = Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections| journal = MMWR. Morbidity and mortality weekly report| date = 2012–08–10| pmid = 22874837}}</ref>
:::* Penicillin MIC &lt; 0.1 μg/mL
:::* Preferred regimen: [[Ceftriaxone]] 1–2 g IV q12h for 10–14 days
 
::*3.9 '''Neisseria meningitidis'''
:::*3.9.1 '''Penicillin MIC &lt; 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/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
:::::* Alternative regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Chloramphenicol]] 4–6 g/day IV q6h


:::* Penicillin MIC 0.1–1.0 μg/mL
:::*3.9.2 '''Penicillin MIC 0.1–1.0 μg/mL'''
:::::* 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}} [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h {{or}} [[Meropenem]] 6 g/day IV q8h
:::::* 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


::* '''Pseudomonas aeruginosa'''
::*3.10 '''Pseudomonas aeruginosa'''
:::* Preferred regimen: [[Cefepime]] 6 g/day IV q8h {{or}} [[Ceftazidime]] 6 g/day IV q8h
:::* Preferred regimen: [[Cefepime]] 6 g/day IV q8h {{or}} [[Ceftazidime]] 6 g/day IV q8h
:::* 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: [[Aztreonam]] 6–8 g/day IV q6–8h {{or}} [[Ciprofloxacin]] 800–1200 mg IV q8–12h {{or}} [[Meropenem]] 6 g/day IV q8h


::* '''Staphylococcus aureus'''
::*3.11 '''Staphylococcus aureus'''
:::* Methicillin susceptible (MSSA)
:::*3.11.1 '''Methicillin susceptible (MSSA)'''
::::* Preferred regimen: [[Nafcillin]] 9–12 g/day IV q4h {{or}} [[Oxacillin]] 9–12 g/day IV q4h
::::* Preferred regimen: [[Nafcillin]] 9–12 g/day IV q4h {{or}} [[Oxacillin]] 9–12 g/day IV q4h
::::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{or}} [[Meropenem]] 6 g/day IV q8h
::::* Alternative regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h {{or}} [[Meropenem]] 6 g/day IV q8h


:::* Methicillin resistant (MRSA)
:::*3.11.2 '''Methicillin resistant (MRSA)'''
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
::::* Preferred regimen: [[Vancomycin]] 30–45 mg/kg/day IV q8–12h
::::* Alternative regimen: [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}} [[Linezolid]] 600 mg IV q12h
::::* Alternative regimen: [[Trimethoprim-Sulfamethoxazole]] 10–20 mg/kg/day q6–12h {{or}} [[Linezolid]] 600 mg IV q12h
::::: Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients.
::::* Note: Consider the addition of [[Rifampin]] 600 mg qd or 300–450 mg bid to [[Vancomycin]] in adult patients.


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


::* '''Streptococcus agalactiae'''
::*3.13 '''Streptococcus agalactiae'''
:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{or}} [[Penicillin G]] 24 MU/day IV q4h
:::* Preferred regimen: [[Ampicillin]] 12 g/day IV q4h {{or}} [[Penicillin G]] 24 MU/day IV q4h
:::* 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


::* '''Streptococcus pneumoniae'''
::*3.14 '''Streptococcus pneumoniae'''
:::* Penicillin MIC < 0.1 μg/mL
:::*3.14.1 '''Penicillin MIC < 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/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
::::* Alternative regimen: [[Ceftriaxone]] 4 g IV q12–24h {{or}} [[Cefotaxime]] 8–12 g/day q4–6h {{or}} [[Chloramphenicol]] 4–6 g/day IV q6h


:::* Penicillin MIC 0.1–1.0 μg/mL
:::*3.14.2 '''Penicillin MIC 0.1–1.0 μg/mL'''
::::* 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
::::* Alternative regimen: [[Cefepime]] 6 g/day IV q8h {{or}} [[Meropenem]] 6 g/day IV q8h


:::* Penicillin MIC ≥ 2.0 μg/mL
:::*3.14.3 '''Penicillin MIC ≥ 2.0 μg/mL'''
::::* 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)
::::* 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)
::::* Alternative regimen: [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h
::::* Alternative regimen: [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h


:::* Cefotaxime or ceftriaxone MIC ≥ 1.0 μg/mL
:::*3.14.4 '''Cefotaxime or ceftriaxone MIC ≥ 1.0 μg/mL'''
::::* 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)
::::* 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)
::::* Alternative regimen: [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h
::::* Alternative regimen: [[Gatifloxacin]] 400 mg/day IV q24h {{or}} [[Moxifloxacin]] 400 mg/day IV q24h


:* Pediatric dose:
::*3.15 '''Treponema pallidum (neurosyphilis)'''<ref>{{Cite journal| issn = 1545–8601| volume = 59| issue = RR–12| pages = 1–110| last1 = Workowski| first1 = Kimberly A.| last2 = Berman| first2 = Stuart| last3 = Centers for Disease Control and Prevention (CDC)| title = Sexually transmitted diseases treatment guidelines, 2010| journal = MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control| date = 2010–12–17| pmid = 21160459}}</ref>
:::* Preferred regimen: [[Aqueous crystalline penicillin G]] 3–4 MU IV q4h or continuously for 10–14 days
:::* Alternative regimen: [[Procaine penicillin G]] 2.4 MU IM q24h for 10–14 days {{and}} [[Probenecid]] 500 mg PO qid for 10–14 days
:::* Note: [[Benzathine penicillin G]] 2.4 MU IM once per week for up to 3 weeks may be considered after completion of above mentioned regimens to provide a comparable total duration of therapy.
 
::*3.16 '''''Borrelia burgdorferi''''' '''(Lyme meningitis)'''
:::* Preferred regimen (1): [[Ceftriaxone]] 2 g IV q24h for 14 days
:::* Preferred regimen (2):[[Cefotaxime]] 2 g IV q8h for 14 days 
:::* Preferred regimen (3):[[Penicillin G]] 18–24 MU/day q4h for 14 days
:::* Alternative regimen: [[Doxycycline]] 100–200 mg BID for 14 days
:::* Pediatric regimen: [[Ceftriaxone]] 50–75 mg/kg/day IV q24h, max 2 g/day {{or}} [[Cefotaxime]] 150–200 mg/kg/day IV q6–8h, max 6 g/day {{or}} [[Penicillin G]] 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day {{or}} [[Doxycycline]] (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
 
:*4. '''Pediatric dose:'''
::* [[Amikacin]]
::* [[Amikacin]]
:::* Neonates age 0–7 days: 15–20 mg/kg/day q12h
:::* Neonates age 0–7 days: 15–20 mg/kg/day q12h
Line 266: Line 285:
:::* Neonates age 8–28 days: 30–45 mg/kg/day q6–8h
:::* Neonates age 8–28 days: 30–45 mg/kg/day q6–8h
:::* Infants and children: 60 mg/kg/day q6h
:::* Infants and children: 60 mg/kg/day q6h
==References==
{{reflist|2}}

Latest revision as of 17:38, 6 October 2015

  • Bacterial meningitis[1]
  • 1. Empiric antimicrobial therapy based on specific predisposing factors
  • 1.1 Age
  • 1.1.1 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)
  • 1.1.2 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)
  • 1.1.3 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)
  • 1.1.4 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)
  • 1.2 Head trauma
  • 1.2.1 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)
  • 1.2.2 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)
  • 1.3 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)
  • 1.4 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)
  • 2. CSF Gram stain-directed antimicrobial therapy
  • 2.1 Gram positive, lancet-shaped diplococci suggestive of Streptococcus pneumoniae
  • 2.2 Gram negative diplococci suggestive of Neisseria meningitidis
  • 2.3 Gram positive, short bacilli suggestive of Listeria monocytogenes
  • 2.4 Gram positive cocci in short chains suggestive of Streptococcus agalactiae
  • 2.5 Gram negative coccobacilli suggestive of Haemophilus influenzae
  • 2.6 Gram negative bacilli suggestive of Escherichia coli
  • 3. Pathogen-directed antimicrobial therapy
  • 3.1 Acinetobacter baumannii
  • 3.2 Borrelia burgdorferi[2]
  • Preferred regimen: Ceftriaxone 2 g IV q24h for 10—28 days
  • Alternative regimen: Cefotaxime 2 g IV q8h for 10—28 days OR Penicillin G 3—4 MU IV q4h for 10—28 days OR Doxycycline 100—200 mg PO q12h for 10—28 days
  • 3.3 Enterococcus species
  • 3.3.1 Ampicillin susceptible
  • 3.3.2 Ampicillin resistant
  • 3.3.3 Ampicillin and vancomycin resistant
  • 3.4 Escherichia coli and other Enterobacteriaceae
  • 3.5 Haemophilus influenzae
  • 3.5.1 β-Lactamase negative
  • 3.5.2 β-Lactamase positive
  • 3.6 Listeria monocytogenes
  • 3.7 Mycobacterium tuberculosis
  • 3.7.1 First-line therapy (dosing information: [1][2][3])
  • 3.7.2 Second-line therapy (dosing information: [4][5][6])
  • 3.7.3 Tuberculous meningitis caused by susceptible Mycobacterium tuberculosis[3][4][5][6]
  • 3.7.3.1 Intensive phase (adult)
  • Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) for 2 months AND Rifampin 10 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
  • 3.7.3.2 Continuation phase (adult)
  • Preferred regimen: Isoniazid 5 mg/kg (max: 300 mg) for 7–10 months AND Rifampin 10 mg/kg (max: 600 mg) for 7–10 months
  • 3.7.3.3 Intensive phase (pediatric)
  • Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) for 2 months AND Rifampin 10–20 mg/kg (max: 600 mg) for 2 months AND Pyrazinamide 15–30 mg/kg (max: 2 g) for 2 months AND Ethambutol 15–20 mg/kg (max: 1 g) for 2 months
  • 3.7.3.3 Continuation phase (pediatric)
  • Preferred regimen: Isoniazid 10–15 mg/kg (max: 300 mg) for 7–10 months AND Rifampin 10–20 mg/kg (max: 600 mg) for 7–10 months
  • Note (1): World Health Organization guidelines recommend that Ethambutol should be replaced by Streptomycin in tuberculous meningitis.[7] Streptomycin is contraindicated in pregnancy.
  • Note (2): A 9– to 12–month course of treatment is recommended for tuberculous meningitis.[8][9]
Note (3): Adjuvant Dexamethasone 0.3–0.4 mg/kg/day (max: 24 mg) is recommended unless drug resistance is suspected.[10][11]
Note (4): Liaise with microbiology laboratory about genotype testing for drug resistance if there is high risk for MDR-TB.[12]
  • 3.7.4 Tuberculous meningitis caused by Mycobacterium tuberculosis resistant to isoniazid or rifampin
  • 3.7.4.1 Isoniazid monoresistance[13]
  • 3.7.4.2 Rifampin monoresistance[14]
  • 3.7.4.3 MDR-TB (resistant to Isoniazid and Rifampin)[15]
  • MDR tuberculosis therapy should be considered if there is a history of prior tuberculosis treatment, contact with a patient with MDR tuberculosis, or a poor clinical response to first-line TB therapy within 2 weeks despite a firm diagnosis and an adequate adherence to treatment.
  • Second-line agents such as Aminoglycosides penetrate the BBB only in the presence of inflamed meninges, and Fluoroquinolones, while able to penetrate into the CNS, have lower CSF levels than in the serum or brain parenchyma.
  • Consult infectious disease specialist.
  • 3.7.4.4 XDR-TB (resistant to Isoniazid, Rifampin, Fluoroquinolones, and either Capreomycin, Kanamycin, or Amikacin)[16]
  • Preferred regimen: Ceftriaxone 1–2 g IV q12h for 10–14 days
  • 3.9 Neisseria meningitidis
  • 3.9.1 Penicillin MIC < 0.1 μg/mL
  • 3.9.2 Penicillin MIC 0.1–1.0 μg/mL
  • 3.10 Pseudomonas aeruginosa
  • 3.11 Staphylococcus aureus
  • 3.11.1 Methicillin susceptible (MSSA)
  • 3.11.2 Methicillin resistant (MRSA)
  • 3.12 Staphylococcus epidermidis
  • Preferred regimen: Vancomycin 30–45 mg/kg/day IV q8–12h
  • Alternative regimen: Linezolid 600 mg IV q12h
  • 3.13 Streptococcus agalactiae
  • 3.14 Streptococcus pneumoniae
  • 3.14.1 Penicillin MIC < 0.1 μg/mL
  • 3.14.2 Penicillin MIC 0.1–1.0 μg/mL
  • 3.14.3 Penicillin MIC ≥ 2.0 μg/mL
  • 3.14.4 Cefotaxime or ceftriaxone MIC ≥ 1.0 μg/mL
  • 3.15 Treponema pallidum (neurosyphilis)[19]
  • 3.16 Borrelia burgdorferi (Lyme meningitis)
  • Preferred regimen (1): Ceftriaxone 2 g IV q24h for 14 days
  • Preferred regimen (2):Cefotaxime 2 g IV q8h for 14 days
  • Preferred regimen (3):Penicillin G 18–24 MU/day q4h for 14 days
  • Alternative regimen: Doxycycline 100–200 mg BID for 14 days
  • Pediatric regimen: Ceftriaxone 50–75 mg/kg/day IV q24h, max 2 g/day OR Cefotaxime 150–200 mg/kg/day IV q6–8h, max 6 g/day OR Penicillin G 200,000–400,000 U/kg/day IV q4h, max 18–24 MU/day OR Doxycycline (≥ 8 y/o) 4–8 mg/kg/day q12h, max 200 mg/day
  • 4. 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

References

  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.
  2. ↑ Wormser, GP.; Dattwyler, RJ.; Shapiro, ED.; Halperin, JJ.; Steere, AC.; Klempner, MS.; Krause, PJ.; Bakken, JS.; Strle, F. (2006). "The clinical assessment, treatment, and prevention of lyme disease, human granulocytic anaplasmosis, and babesiosis: clinical practice guidelines by the Infectious Diseases Society of America". Clin Infect Dis. 43 (9): 1089–134. doi:10.1086/508667. PMID 17029130. Unknown parameter |month= ignored (help)
  3. ↑ Blumberg, Henry M.; Burman, William J.; Chaisson, Richard E.; Daley, Charles L.; Etkind, Sue C.; Friedman, Lloyd N.; Fujiwara, Paula; Grzemska, Malgosia; Hopewell, Philip C.; Iseman, Michael D.; Jasmer, Robert M.; Koppaka, Venkatarama; Menzies, Richard I.; O'Brien, Richard J.; Reves, Randall R.; Reichman, Lee B.; Simone, Patricia M.; Starke, Jeffrey R.; Vernon, Andrew A.; American Thoracic Society, Centers for Disease Control and Prevention and the Infectious Diseases Society (2003-02-15). "American Thoracic Society/Centers for Disease Control and Prevention/Infectious Diseases Society of America: treatment of tuberculosis". American Journal of Respiratory and Critical Care Medicine. 167 (4): 603–662. doi:10.1164/rccm.167.4.603. ISSN 1073-449X. PMID 12588714.
  4. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
  5. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  6. ↑ American Thoracic Society; CDC; Infectious Diseases Society of America (2003-06-20). "Treatment of tuberculosis". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 52 (RR-11): 1–77. ISSN 1057-5987. PMID 12836625.
  7. ↑ Treatment of Tuberculosis: Guidelines. WHO Guidelines Approved by the Guidelines Review Committee (4th ed.). Geneva: World Health Organization. 2010. ISBN 9789241547833. PMID 23741786. Retrieved 2015-06-08.
  8. ↑ Treatment of Tuberculosis: Guidelines. WHO Guidelines Approved by the Guidelines Review Committee (4th ed.). Geneva: World Health Organization. 2010. ISBN 9789241547833. PMID 23741786. Retrieved 2015-06-08.
  9. ↑ American Thoracic Society; CDC; Infectious Diseases Society of America (2003-06-20). "Treatment of tuberculosis". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 52 (RR-11): 1–77. ISSN 1057-5987. PMID 12836625.
  10. ↑ Thwaites, Guy E.; Nguyen, Duc Bang; Nguyen, Huy Dung; Hoang, Thi Quy; Do, Thi Tuong Oanh; Nguyen, Thi Cam Thoa; Nguyen, Quang Hien; Nguyen, Tri Thuc; Nguyen, Ngoc Hai; Nguyen, Thi Ngoc Lan; Nguyen, Ngoc Lan; Nguyen, Hong Duc; Vu, Ngoc Tuan; Cao, Huu Hiep; Tran, Thi Hong Chau; Pham, Phuong Mai; Nguyen, Thi Dung; Stepniewska, Kasia; White, Nicholas J.; Tran, Tinh Hien; Farrar, Jeremy J. (2004-10-21). "Dexamethasone for the treatment of tuberculous meningitis in adolescents and adults". The New England Journal of Medicine. 351 (17): 1741–1751. doi:10.1056/NEJMoa040573. ISSN 1533-4406. PMID 15496623.
  11. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  12. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  13. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  14. ↑ Thwaites, Guy; Fisher, Martin; Hemingway, Cheryl; Scott, Geoff; Solomon, Tom; Innes, John; British Infection Society (2009-09). "British Infection Society guidelines for the diagnosis and treatment of tuberculosis of the central nervous system in adults and children". The Journal of Infection. 59 (3): 167–187. doi:10.1016/j.jinf.2009.06.011. ISSN 1532-2742. PMID 19643501. Check date values in: |date= (help)
  15. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
  16. ↑ Rock, R. Bryan; Olin, Michael; Baker, Cristina A.; Molitor, Thomas W.; Peterson, Phillip K. (2008-04). "Central nervous system tuberculosis: pathogenesis and clinical aspects". Clinical Microbiology Reviews. 21 (2): 243–261, table of contents. doi:10.1128/CMR.00042-07. ISSN 1098-6618. PMC 2292571. PMID 18400795. Check date values in: |date= (help)
  17. ↑ Workowski, Kimberly A.; Berman, Stuart; Centers for Disease Control and Prevention (CDC) (2010–12–17). "Sexually transmitted diseases treatment guidelines, 2010". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR–12): 1–110. ISSN 1545-8601. PMID 21160459. Check date values in: |date= (help)
  18. ↑ Centers for Disease Control and Prevention (CDC) (2012–08–10). "Update to CDC's Sexually transmitted diseases treatment guidelines, 2010: oral cephalosporins no longer a recommended treatment for gonococcal infections". MMWR. Morbidity and mortality weekly report. 61 (31): 590–594. ISSN 1545-861X. PMID 22874837. Check date values in: |date= (help)
  19. ↑ Workowski, Kimberly A.; Berman, Stuart; Centers for Disease Control and Prevention (CDC) (2010–12–17). "Sexually transmitted diseases treatment guidelines, 2010". MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control. 59 (RR–12): 1–110. ISSN 1545-8601. PMID 21160459. Check date values in: |date= (help)
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