Table 4.
Antibiotic therapy of acute bacterial meningitis in proven pathogens
| Pathogen | Antibiotics1 |
|---|---|
| Neisseria meningitidis 2 | |
| - ceftriaxone/cefotaxim-susceptible (MIC ≤ 0,125 mg/l) | ceftriaxone3 |
| - ceftriaxone/cefotaxim-resistant (MIC > 0,125 mg/l) | meropenem |
| Streptococcus pneumoniae | |
| - ceftriaxone/cefotaxim-susceptible (MIC ≤ 0,5 mg/l) | ceftriaxone3 |
| meropenem | |
| - ceftriaxone/cefotaxim-resistant (MIC > 0,5 mg/l) | ceftriaxone3 + vancomycin, |
| ceftriaxone3 + rifampicin4, | |
| Meropenem | |
| Haemophilus influenzae | ceftriaxone3, |
| ampicillin | |
| Groupp-B-streptococci (Streptococcus agalactiae) | penicillin G, |
| ceftriaxone, | |
| ampicillin, | |
| vancomycin | |
| Gram-negative enterobacterales (e.g. Klebsiella spp., E. coli, Proteus spp.) | ceftriaxone3, |
| meropenem, | |
| cefepime | |
| Pseudomonas aeruginosa | ceftazidime, |
| meropenem, | |
| cefepime | |
| (combination with fosfomycin4can be considered) | |
| Staphylococci | |
| - methicillin-susceptible | cefazolin, |
| flucloxacillin | |
| (combination with fosfomycin4 or | |
| rifampicin4 can be considered) | |
| vancomycin, | |
| - Methicillin-resistant | linezolid5 |
| (combination with fosfomycin4 or | |
| rifampicin4 can be considered) | |
| Listeria monocytogenes | ampicillin, |
| trimethoprim-sulfamethoxazol, | |
| meropenem | |
| (combination with fosfomycin4 or | |
| rifampicin4 can be considered) |
1The choice of the antibiotic depends on the susceptibility of the pathogen. 2During the last years, an increasing rate of resistances against penicillin was found for meningococci in Germany (2019: 5,9%, 2020: 3,9% und 2021: 8,5%, Nationales Referenzzentrum für Meningokokken und Haemophilus influenzae). In consequence, invasive meningococcal disease should not be treated with penicillin before the results of resistancy testing are available. However, as group A cephalosporins are usually effective against meningococci and as the results of resistancy testing are time consuming (usually taking several days), a possible benefit of changing the initially administered group A cephalosporine to penicillin seems questionable, even if the isolated pathogen is tested susceptible to penicillin. 3or cefotaxim. 4rifampicin, fosfomycin and aminoglykosides should not be given as monotherapy. 5linezolid is comparable ot vancomycin in terms of the covered pathogens and it penetrates well into the CSF; there are several reports on the use of linezolid in staphylococcal infections of the CNS [41, 42]. Linezolid should not be used as first-line medication. Its use should be considered when linezolid-susceptible bacteria are found causative for the CNS infection or (a) there are contraindications for vancomycin or vancomycin has to be stopped because of side effects, or (b) a clinical worsening is observed under therapy with vancomycin. In staphylococcal meningitis or ventriculitis, sufficient levels of linezolid are reached in the CSF [43], but as it is only moderately bactericidal, its use is of theroretical risk for the success of the therapy in meningitis