Table 3.

Empiric antibiotic therapy in acute bacterial meningitis in adults

Clinical Condition	Recommended antiobitics
Community-acquired, no immunosuprression	cephalosporine group 3a1 plus ampicillin2
Post neurosurgery or post brain trauma	vancomycin plus meropenem or vancomycin plus ceftazidime3 (plus metronidazole in case of surgery that include mucous membranes)
Immunosuppression	vancomycin plus meropenem4
Shunt-infection	vancomycin plus meropenem or vancomycin plus ceftazidime

¹E.g. ceftriaxone or cefotaxim. ²In regions with a high rate of cephalosporine-resistant pneumococci (e.g. France, Spain, Hungary, Australia, Southern Africa, Northern America initial treatment with a combination of ceftriaxone, vancomycin and ampicillin or ceftriaxone, rifampicin and ampicillin is recommended. ³or vancomycin plus cefepime. In cases of proven ventriculitis due to Staphylococcus aureus, intrathecal vancomycin can be considered [40]. ⁴Dependent on the clinical constellation, coverage of further pathogens (e.g. fungi) can be necessary