Table 7.
Empirical treatment recommendations for suspected bacterial meningitis
| Initial treatment recommendations* | |||||
|---|---|---|---|---|---|
| CMG | 3rd-generation cephalosporin (ceftriaxone^ or cefotaxime) | 3rd generation-cephalosporin (ceftriaxone^ or cefotaxime) plus a penicillin (amoxicillin, ampicillin or penicillin) | Aminoglycoside (gentamicin) plus a penicillin (amoxicillin or ampicillin) | Add: glycopeptide (vancomycin) | Add: corticosteroids (before or with first dose of antibiotics) |
| EFNS Europe | P, A | E | Older children and adults** | Yes | |
| ESCMID Europe | P, A | N, A > 50 years, or if risk factor for L. monocytogenes | N | **,^ | Yes^ up to 4 h post-antibiotics |
| DSI Denmark | A | A if risk of L. monocytogenes | Yes | ||
| SPILF France | P, A | P, A if suspected L. monocytogenes° | If S. pneumoniae | Yes″ | |
| DGN: BM Germany | A | A | A** | Yes | |
| HPSC Ireland | P > 2 m, A | N, P < 2 months | N, P < 2 months | **,^ | Yes up to 24 h post-antibiotics |
| NVN Netherlands | P, A | N, A | Yes | ||
| MHSSE# Spain | P | Yes | |||
| NICE UK | P > 3 m | N, P < 3 months | If travel outside of the UK | Yes^^ up to 12 h post-antibiotics | |
| UKJSS UK | A | A > 60 years | Pending travel history | Yes up to 12 h post-antibiotics | |
| SIGN# Scotland | P > 3 m | N, P ≤ 3 months | Yes up to 24 h post-antibiotics | ||
| IDSA USA/Global | P, A | N, A > 50 years | N | P, A | P^, infants if Hib, A |
| AEPED Spain | P | N, P ≤ 3 months | **,^ | Yes | |
| MSF Global | P > 3 m, A | N, P ≤ 3 months | N, P ≤ 3 months | Yes^ | |
| NNF Norway | NS | NS | Yes | ||
The table shows empirical treatment recommendations for different risk groups
*Initial recommendations to be reviewed as appropriate pending diagnostic results
**If suspicion of reduced sensitivity to penicillin
^Not to neonates
^^Not to infants < 3 months
″Not to immunosuppressed
#Focused on N. meningitidis only
Abbreviations: N neonate, P paediatric populations, A adults, E elderly, NS non-specified population, EFNS European Federation of Neurological Societies, ESCMID European Society of Clinical Microbiology and Infectious Diseases, DSI Dansk Selskab for Infektionsmedicin, SPILF Société de Pathologie Infectieuse de Langue Française, DGN Deutsche Gesellschaft für Neurologie, BM Bakterielle Meningoenzephalitis, HPSC Health Protection Surveillance Centre, NVN Nederlandse Vereniging voor Neurologie, MHSSE Ministry of Health, Social Services and Equality, NICE The National Institute for Health and Care Excellence, UKJSS UK Joint Specialist Societies, SIGN Scottish Intercollegiate Guidelines Network, IDSA Infectious Diseases Society of America, AEPED Asociación Española de Pediatría, MSF Médecins Sans Frontières, NNF Norsk Nevrologisk Forening