Table 2.

Empirical antimicrobial therapy for suspected bacterial meningitis by age group

Age-group	Most frequently isolated bacterial pathogens	Empiric antimicrobial therapy*
Neonates	Listeria monocytogenes Escherichia coli (or other enteric-gram negative bacilli) Streptococcus agalactiae	Ampicillin plus Cefotaxime or Gentamicin
1–24 months	Streptococcus agalactiae Escherichia coli Streptococcus pneumoniae Neisseria meningitidis** Haemophilus influenzae b**	Vancomycin + cefotaxime or ceftriaxone
2–50 years	Streptococcus agalactiae Escherichia coli Streptococcus pneumoniae Haemophilus influenzae b**	Vancomycin + cefotaxime or ceftriaxone + ampicillin***
50 years and older	Streptococcus pneumoniae Neisseria meningitidis Listeria monocytogenes	Vancomycin + ceftriaxone or cefotaxime + ampicillin***

^*The intravenous route is the preferred mode of administration of antimicrobials

^**Ceftriaxone is preferred over chloramphenicol for treating H. influenza b meningitis, given the increasing antimicrobial resistance of this pathogen to chloramphenicol. The administration of one or two doses of long-acting chloramphenicol is recommended during outbreaks of N. meningitidis; alternatively, intramuscular administration of ceftriaxone is considered an alternative

^***Trimethoprim/sulfamethoxazole is recommended for cases of severe penicillin-allergy