Template:Meningitis Antibiotics: Difference between revisions
No edit summary |
Ostermayer (talk | contribs) No edit summary |
||
| Line 3: | Line 3: | ||
{{Neonatal meningitis antibiotics}} | {{Neonatal meningitis antibiotics}} | ||
===> 1 month | ===> 1 month old === | ||
{{Pediatric meningitis antibiotics}} | |||
=== | ===Adult < 50 yr=== | ||
{{Young adult meningitis antibiotics}} | |||
===Adult > 50 yr=== | |||
{{Elderly adult meningitis antibiotics}} | |||
===Post Procedural (or penetrating trauma)=== | ===Post Procedural (or penetrating trauma)=== | ||
*[[Vancomycin]] 15-20mg/kg IV BID daily '''PLUS''' | *[[Vancomycin]] 15-20mg/kg IV BID daily '''PLUS''' | ||
*[[Cefepime]] 2g (50mg/kg) IV q8 hours daily '''OR''' [[Ceftazidime]] 2g (50mg/kg) IV q8 hours daily '''OR''' [[Meropenem]] 2gm (40mg/kg) IV q8 hours daily | *[[Cefepime]] 2g (50mg/kg) IV q8 hours daily '''OR''' [[Ceftazidime]] 2g (50mg/kg) IV q8 hours daily '''OR''' [[Meropenem]] 2gm (40mg/kg) IV q8 hours daily | ||
===[[Cryptococcosis]] Meningitis=== | ===[[Cryptococcosis]] Meningitis=== | ||
{{Crypto meningitis antibiotics}} | |||
===[[Neisseria meningitidis]] Prophylaxis=== | ===[[Neisseria meningitidis]] Prophylaxis=== | ||
{{Neisseria meningitis prophylaxis}} | |||
===Meningitis with severe PCN allergy=== | ===Meningitis with severe PCN allergy=== | ||
{{Meningitis peniccillin allergic antibiotics}} | |||
Revision as of 17:31, 5 July 2015
Treatment guidelines based on van de Beek et al[1]
Neonates (up to 1 month of age)
MRSA is uncommon in the neonate
- Ampicillin 75mg/kg IV q6hrs PLUS
- Cefotaxime 50mg/kg IV q6hrs OR 2.5mg/kg IV q8hrs
- Per AAP, ceftazidime 50mg/kg IV (q12hr for babies < 8 days of age, q8hr for >7 days old) is a reasonable alternative to cefotaxime, offering virtually the same coverage for enteric bacilli and is FDA approved for all age groups[2]
- If suspecting S. pneumoniae or MRSA, add standard neonatal dosing
- Consider acyclovir for HSV
> 1 month old
- Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
- Vancomycin 15-20 mg/kg IV BID daily
- Vancomycin is for resistant Pneumococcus
Alternatives (e.g. penicillin/cephalosporin allergy):
- Meropenem 40mg/kg IV q8hrs (max 2g/dose)
- Chloramphenicol 75-100mg/kg/day IV divided q6h (max 4g/day)
Adult < 50 yr
- Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
- Vancomycin 15-20 mg/kg IV BID daily
- Vancomycin is for resistant Pneumococcus
Adult > 50 yr
- Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
- Vancomycin 15-20 mg/kg IV BID daily PLUS
- Ampicillin 2gm IV q4h (hourly if listeria suspected)[3]
Post Procedural (or penetrating trauma)
- Vancomycin 15-20mg/kg IV BID daily PLUS
- Cefepime 2g (50mg/kg) IV q8 hours daily OR Ceftazidime 2g (50mg/kg) IV q8 hours daily OR Meropenem 2gm (40mg/kg) IV q8 hours daily
Cryptococcosis Meningitis
Options
- Amphotericin B 1mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
- Amphotericin B 5mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
Neisseria meningitidis Prophylaxis
- Ceftriaxone 250mg IM once
- Ceftriaxone 125mg IM once (if <=15yr)
- Ciprofloxacin 500mg PO once
- Rifampin 600 mg PO BID x 2 days
- Rifampin <1mo: 5mg/kg PO BID x 2 days; >=1mo: 10mg/kg PO BID x 2 days
Meningitis with severe PCN allergy
- Chloramphenicol 1g IV q6h + 15mg/kg q8-12hr
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
- ↑ https://www.aappublications.org/content/early/2015/02/25/aapnews.20150225-1
- ↑ [Guideline] Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008 Jul. 15(7):649-59.