Table 2:
Antibiotics that may be used to complete therapy for bacterial meningitis once antibiotic susceptibility testing is available
| Etiological agent and antibiotic susceptibility | Antibiotics that can be used to complete therapy | Recommended total duration of therapy for uncomplicated meningitis* |
|---|---|---|
| Streptococcus pneumoniae | ||
| Fully susceptible to penicillin or third-generation cephalosporins (MIC<0.1 mg/L) | Penicillin G 250,000 U/kg/day divided every 4 to 6 h or cefotaxime 200 mg/kg/day divided every 6 to 8 h or ceftriaxone 100 mg/kg/day divided every 24 h | 7 to 14 days |
| Intermediate- or high-level resistance to penicillin or third-generation cephalosporins (MIC≥0.1 mg/L) | Intravenous vancomycin 60 mg/kg/day divided every 6 h (aiming for a peak serum vancomycin level of 30 to 40 mg/L and a trough level of 5 to 10 mg/L) plus either cefotaxime or ceftriaxone (doses as specified in Table 1)† | 7 to 14 days |
| Neisseria meningitidis | Penicillin G 250,000 U/kg/day divided every 4 to 6 h | 5 to 7 days |
| Haemophilus influenzae type b | ||
| Beta-lactamase negative | Ampicillin 300 mg/kg/day divided every 6 h | 7 to 10 days |
| Beta-lactamase positive | Cefotaxime 200 mg/kg/day divided every 6 to 8 h or ceftriaxone 100 mg/kg/day divided every 24 h | 7 to 10 days |
| Group B streptococcus (May cause bacterial meningitis in infants up to 3 months of age) |
Penicillin G 450,000 U/kg/day divided every 6 h or ampicillin 300 mg/kg/day divided every 6 h plus gentamicin 7.5 mg/kg/day divided every 8 h for first week | 14 to 21 days |
| Enteric Gram-negative organism (May cause bacterial meningitis in infants up to 3 months of age) |
Either of cefotaxime 200 mg/kg/day divided every 6 to 8 h or ceftriaxone 100 mg/kg/day divided every 24 h plus gentamicin 7.5 mg/kg/day divided every 8 h | 21 days |
| Culture is negative but bacterial etiology is suspected or cannot be ruled out (Note that antigen detection testing of cerebrospinal fluid for pneumococcus, meningococcus and H influenzae type b is not considered sensitive or specific enough to be helpful in these situations) |
Cefotaxime 200 mg/kg/day divided every 6 to 8 h or ceftriaxone 100 mg/kg/day divided every 24 h with or without vancomycin (depending on the clinical level of suspicion) 60 mg/kg/day intravenously divided every 6 h (aiming for a peak serum vancomycin level of 30 to 40 mg/L and a trough level of 5 to 10 mg/L) | 7 to 10 days |
*
Minimum durations for uncomplicated meningitis;
†
Expert opinion from an infectious diseases specialist regarding the need for an alternative antibiotic should be sought if a patient has any contraindication to cefotaxime or ceftriaxone. MIC Minimum inhibitory concentration