Treatment of Bacterial Meningitis

Empirical Treatment

The American College of Physicians recommends empiric therapy with 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, 3
For adults <60 years of age, the Infectious Diseases Society of America recommends ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours as initial antibiotic selection 1, 3
For adults ≥60 years of age, the Infectious Diseases Society of America recommends ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours, plus amoxicillin 2g IV every 4 hours for Listeria coverage 1, 4

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

The Infectious Diseases Society of America recommends that patients with no identified pathogen can discontinue treatment if recovered by day 10 6
For suspected meningococcal sepsis without lumbar puncture, treatment can be stopped if recovered by day 5 with typical petechial/purpuric rash 6
The Infectious Diseases Society of America recommends considering outpatient IV therapy for clinically well patients 6
For Gram-negative bacilli meningitis, the Infectious Diseases Society of America recommends continuing ceftriaxone/cefotaxime and seeking specialist advice regarding local resistance patterns, with a duration of 21 days 6

The Infectious Diseases Society of America recommends checking recent travel history and consulting local infectious disease expertise if patient has visited areas with high resistance rates 4, 7
The Infectious Diseases Society of America recommends considering adjunctive therapy with dexamethasone for suspected bacterial meningitis, especially for pneumococcal meningitis 8