. 2010 Jul;23(3):467–492. doi: 10.1128/CMR.00070-09

TABLE 4.

Specific antimicrobial therapy for bacterial meningitis based on causative microorganism^d

Microorganism	Standard therapy	Alternative therapy
Haemophilus influenzae
β-Lactamase negative	Ampicillin	Expanded-spectrum cephalosporin^a; cefepime; chloramphenicol; aztreonam; fluoroquinolone
β-Lactamase positive	Expanded-spectrum cephalosporin^a	Cefepime; chloramphenicol; aztreonam; fluoroquinolone
BLNAR	Expanded-spectrum cephalosporin^a plus meropenem	Expanded-spectrum cephalosporin^a plus fluoroquinolone
Neisseria meningitidis
Penicillin MIC < 0.1 μg/ml	Penicillin G or ampicillin	Expanded-spectrum cephalosporin^a; chloramphenicol
Penicillin MIC 0.1-1.0 μg/ml	Expanded-spectrum cephalosporin^a	Chloramphenicol; fluoroquinolone; meropenem
Streptococcus pneumoniae
Penicillin MIC ≤0.1 μg/ml	Penicillin G or ampicillin	Expanded-spectrum cephalosporin^a; chloramphenicol
Penicillin MIC 0.1-1.0 μg/ml	Expanded-spectrum cephalosporin^a	Meropenem; cefepime
Penicillin MIC ≥2.0 μg/ml or cefotaxime or ceftriaxone MIC ≥1.0 mg/ml	Vancomycin plus a third-generation cephalosporin^a^,^b	Expanded-spectrum cephalosporin^a plus moxifloxacin
Listeria monocytogenes	Ampicillin or penicillin G^c	Trimethoprim-sulfamethoxazole
Streptococcus agalactiae	Ampicillin or penicillin G^c	Expanded-spectrum cephalosporin^a
Staphylococcus aureus
Methicillin sensitive	Nafcillin or oxacillin	Vancomycin; meropenem; linezolid; daptomycin
Methicillin resistant	Vancomycin^b	Trimethoprim-sulfamethoxazole; linezolid; daptomycin
Staphylococcus epidermidis	Vancomycin^b	Linezolid
Streptococcus pyogenes	Penicillin	Expanded-spectrum cephalosporin^a

Cefotaxime or ceftriaxone.

Addition of rifampin may be considered (see text for indications).

Addition of an aminoglycoside should be considered.