Version June 2024
| Antimicrobial agent | Dose (adult) |
| Amikacin | 5 mg/kg every 8 hours* |
| Ampicillin | 2 g every 4 hours |
| Aztreonam | 2 g every 6 to 8 hours |
| Cefepime | 2 g every 8 hours |
| Cefotaxime | 2 g every 4 to 6 hours |
| Ceftazidime | 2 g every 8 hours |
| Ceftriaxone | 2 g every 12 hours |
| Chloramphenicol | 1 to 1.5 g every 6 hours¶ |
| Ciprofloxacin | 400 mg every 8 to 12 hours |
| Gentamicin | 1.7 mg/kg every 8 hours* |
| Meropenem | 2 g every 8 hours |
| Moxifloxacin | 400 mg every 24 hoursΔ |
| Nafcillin | 2 g IV every 4 hours |
| Oxacillin | 2 g IV every 4 hours |
| Penicillin G potassium | 4 million units every 4 hours |
| Rifampin | 600 mg every 24 hours◊ |
| Tobramycin | 1.7 mg/kg every 8 hours* |
| Trimethoprim-sulfamethoxazole (cotrimoxazole) | 5 mg/kg every 8 hours§¥ |
| Vancomycin | 15 to 20 mg/kg every 8 to 12 hours‡† |
IV: intravenously; MRSA: methicillin-resistant Staphylococcus aureus; IDSA: Infectious Diseases Society of America.
* Dose based on ideal body weight or dosing weight except in underweight patients. A calculator for ideal body weight and dosing weight is available in UpToDate. Dosage and interval must be individualized to produce a peak serum concentration of 7 to 9 mg/L and trough <1 to 2 mg/L for gentamicin or tobramycin and a peak of 25 to 40 mg/L and trough <4 to 8 mg/L for amikacin. For additional information, refer to the UpToDate topic on aminoglycosides.
¶ The higher dose is recommended for patients with pneumococcal meningitis.
Δ No data on optimal dosage needed in patients with bacterial meningitis.
◊ For the treatment of MRSA meningitis, the IDSA suggests a rifampin dose of 600 mg orally once daily or 300 to 450 mg twice daily.[1]
§ Dosage is based on the trimethoprim component.
¥ We administer trimethoprim-sulfamethoxazole at a dose of 5 mg/kg (based on the trimethoprim component) IV every 8 hours in patients with normal renal function. However, there are limited data on the preferred dosing interval, and in case reports, the dose of trimethoprim-sulfamethoxazole has been administered anywhere from every 6 to every 12 hours. For the treatment of MRSA meningitis, the IDSA suggests a trimethoprim-sulfamethoxazole dose of 5 mg/kg (based on the trimethoprim component) intravenously twice or three times daily.[1]
‡ For treatment of meningitis due to pathogens other than S. aureus, the vancomycin dose should not exceed 2 g per dose or a total daily dose of 60 mg/kg. Adjust dose to achieve vancomycin serum trough concentrations of 15 to 20 mcg/mL.[1]
† For treatment of meningitis due S. aureus, a vancomycin loading dose (20 to 35 mg/kg) is appropriate;[2] within this range, we use a higher dose for critically ill patients. The loading dose is based on actual body weight, rounded to the nearest 250 mg increment and not exceeding 3000 mg. The initial maintenance dose and interval are determined by nomogram (typically 15 to 20 mg/kg every 8 to 12 hours for most patients with normal renal function). 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.
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