Recommendations for antimicrobial therapy of bacterial meningitis in adults with presumptive pathogen identification by positive Gram stain*

Microorganism	Recommended therapy	Alternative therapies
Streptococcus pneumoniae	Vancomycin plus a third-generation cephalosporin^¶^Δ	Fluoroquinolone^◊
Neisseria meningitidis	Third-generation cephalosporin^¶	Chloramphenicol, fluoroquinolone, aztreonam
Listeria monocytogenes	Ampicillin^§ or penicillin G^§	Trimethoprim-sulfamethoxazole
Haemophilus influenzae	Third-generation cephalosporin^¶	Chloramphenicol, cefepime, meropenem, fluoroquinolone

* For recommended dosages, refer to the UpToDate table on recommended intravenous dosages of antimicrobial therapy for adults with bacterial meningitis.
¶ Ceftriaxone or cefotaxime.
Δ Some experts would add rifampin if dexamethasone is also given.
◊ Moxifloxacin is recommended given its excellent cerebrospinal fluid penetration and in vitro activity against Streptococcus pneumoniae, although there are no clinical data available. If used, many authorities would combine moxifloxacin with vancomycin or a third-generation cephalosporin (cefotaxime or ceftriaxone).
§ Addition of an aminoglycoside should be considered.

Modified with permission from: Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267. Copyright © 2004 University of Chicago Press.

Graphic 75922 Version 6.0

خرید پکیج

Recommendations for antimicrobial therapy of bacterial meningitis in adults with presumptive pathogen identification by positive Gram stain*