Treatment of Bacterial Meningitis

Empirical Treatment Algorithm

The American College of Physicians recommends ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours for adults with bacterial meningitis, with additional agents based on patient age and risk factors 1, 2
For adults less than 60 years, ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours is recommended, with vancomycin 15-20mg/kg IV twice daily or rifampicin 600mg twice daily added if penicillin-resistant pneumococci is suspected 2
For adults 60 years or older, ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours plus amoxicillin 2g IV every 4 hours is recommended for Listeria coverage 2, 1

For Streptococcus pneumoniae, benzylpenicillin 2.4g IV every 4 hours or ceftriaxone/cefotaxime is recommended if penicillin-sensitive, with a duration of 10-14 days 2, 1
For Neisseria meningitidis, ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours or benzylpenicillin 2.4g IV every 4 hours is recommended, with a duration of 5 days 2, 1
For Listeria monocytogenes, amoxicillin 2g IV every 4 hours is recommended, with a duration of 21 days 1
For Haemophilus influenzae, ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours is recommended, with a duration of 10 days 1

Recent travel history to countries with high pneumococcal resistance rates should be checked, and local infectious disease expertise should be consulted for up-to-date resistance patterns 2, 1
The European Centre for Disease Prevention and Control website or World Health Organisation can provide resources for resistance data 2
Empirical therapy should be started immediately after obtaining blood cultures and before lumbar puncture results are available, according to the Infectious Diseases Society of America 1
Consider adjunctive dexamethasone therapy, especially for pneumococcal meningitis, as recommended by the American College of Physicians 1