Our suggested approach to antibiotic therapy in patients with confirmed pneumococcal meningitis

CrCl: creatinine clearance; IV: intravenous; MIC: minimum inhibitory concentration.

* Consultation with an infectious diseases specialist is advised for patients with resistant pneumococcal meningitis. For pediatric patients, it is standard practice to add rifampin in this setting. For adults, practice varies depending on the patient's clinical status, comorbidities, potential drug interactions, and clinical preference. Some experts would add rifampin in this setting, and others would add a respiratory fluoroquinolone (eg, moxifloxacin or levofloxacin), while other experts might not add a third agent if the patient has an adequate response to vancomycin plus ceftriaxone/cefotaxime.

¶ The initial vancomycin dose and interval are determined by nomogram utilizing actual body weight and kidney function (CrCl). Subsequent dose and interval adjustments are based on AUC-guided or trough-guided serum concentration monitoring. Refer to the UpToDate topic on vancomycin dosing for a sample nomogram and discussion of vancomycin monitoring.