TABLE 1.
Recommended antimicrobials for suspected and proven bacterial meningitis in children >1 month of age
| Recommended therapy | ||
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| Empirical treatment (pending blood and cerebrospinal fluid cultures) | ||
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| Ceftriaxone OR cefotaxime AND vancomycin | ||
| ADD ampicillin to cover Listeria if patients are at risk because they are immunocompromised | ||
|
| ||
| Blood and CSF cultures negative or not performed, but a diagnosis of bacterial meningitis is supported by clinical course and laboratory investigations (including cases detected using molecular methods) | ||
|
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| Ceftriaxone OR cefotaxime, without vancomycin* | ||
| *Vancomycin could be continued if there is local epidemiological evidence of third-generation cephalosporin resistance of Streptococcus pneumoniae | ||
|
| ||
| Specific bacteria | Recommended treatment | Alternative therapy |
|
| ||
| S pneumoniae (culture positive) | ||
| Penicillin susceptible (MIC ≤0.06 μg/mL) | Penicillin G or ampicillin | Cefotaxime, ceftriaxone |
| Penicillin resistant (MIC ≥0.12 μg/mL) | Ceftriaxone or cefotaxime | Meropenem |
| AND ceftriaxone or cefotaxime susceptible (MIC ≤0.5 μg/mL) | ||
| Penicillin resistant (MIC ≥0.12 μg/mL) | Ceftriaxone or cefotaxime AND vancomycin* | Meropenem |
| AND ceftriaxone or cefotaxime intermediate or fully resistant (MIC ≥1.0 μg/mL) | *Consult an infectious disease expert | |
| Neisseria meningitidis | ||
| Penicillin susceptible (MIC <0.12 μg/mL) | Penicillin G or ampicillin | Ceftriaxone or cefotaxime |
| Penicillin resistant (MIC ≥0.12 μg/mL) | Ceftriaxone or cefotaxime | |
| Haemophilus influenzae | ||
| Ampicillin susceptible | Ampicillin | |
| Ampicillin resistant | Ceftriaxone or cefotaxime | |
| Streptococcus agalactiae (Group B streptococci [GBS]) | Penicillin G or ampicillin; ADD gentamicin for the first 5 to 7 days or until cerebrospinal fluid sterility confirmed | |
| Other organisms | Consult an infectious disease expert | |
MIC Minimum inhibitory concentration