Infectious Diseases in Critical Care Medicine

Table 12

Empiric Therapy of Acute Bacterial Meningitis (ABM)

Subset

Usual pathogens

Preferred IV therapy

Alternate IV therapy

IV-to-PO switch

Normal Host

Neisseria meningitidisHaemophilus influenzaeStreptococcus pneumoniae

Ceftriaxone 2 g (IV)

q12h



2wk

Meropenem 2 g (IV)

q8h



2 wk or Cefotaxime

3g (IV) q6h



2wkor

Ceftizoxime 3 g (IV)q6h



2wk

Chloramphenicol 500 mg

(PO) q6h



2wk

Elderly or malignancy

Listeria monocytogenes

(plus usual meningealpathogens in normalhosts)

Before culture results:

Ceftriaxone 2 g (IV)q12h



2 wk plus

Ampicillin 2 g (IV)q4h



2wk

After culture results:

Listeria

present

Ampicillin 2 g (IV) q4h



2wkor

Chloramphenicol 500 mg(IV) q6h



2wk

After culture results for

Listeria

present:

TMP–SMX 5 mg/kg (PO)q6h



2wkor

Chloramphenicol 500 mg(PO) q6h



2wk

After culture results

Listeria

present:

Ampicillin 2 g (IV)q4h



2wk

Listeria

not present:

Treat as normal host

Listeria

not present:

Treat as normal host

Listeria

not present:

Chloramphenicol 500 mg(PO) q6h



2wk

CNS shunt infections (VA

shunts)* (Treat initially forMSSA; if later, identifiedas MRSA, MSSE, orMRSE, treat accordingly.)

Staphylococcus aureusStaphylococcus

epidermidis

(CoNS)

MSSA/MSSE Cefotaxime or

Ceftizoxime 3 g (IV) q6h

a

or

Linezolid 600 mg (IV) q12h

a

MRSA/MRSE Linezolid 600 mg

(IV) q12h

a

MSSA/MSSE Meropenem 2 g (IV)

q8h



2wk

a

or Cefepime 2 g (IV)

q8h

a

MRSA/MRSE Vancomycin

1 g (IV) q12h

a

plus 20 mg (IT)

q24h until shunt removal

MSSA/MRSE Linezolid 600 mg

(PO) q12h

a

MSSA/MRSA Minocycline

100 mg (PO) q12h

a

or

Linezolid 600 mg (PO) q12h

a

CNS shunt infections (VP

shunts)*

Escherichia coliKlebsiella pneumoniaeEnterobacterAcinetobacter baumannii

Ceftriaxone 2 g (IV)

q12h



2 wk after

shunt removal or Ceftizoxime orCefotaxime 3 g (IV)q6h



2 wk after

shunt removal

Meropenem 2 g (IV)

q8h



2 wk after shunt removal

Meropenem 2 g (IV) q8h



2 wk after

shunt removal. TMP/SMX 5 mg/kg(IV) q6h



2 wk after shunt removal

Sulbactam/ampicillin 4.5 g (IV)

q6h



2 wk after shunt removal

TMP–SMX 5 mg/kg (PO)

q6h



2 wk after shunt

removal

None

Note:

Duration of therapy represents total time IV or IV

þ

PO. Most patients on IV therapy able to take PO meds should be switched to PO therapy after clinical improvement.

*Remove CNS shunt as soon as possible.aTreat for 1 wk after shunt removal.Abbreviations

: ABM, acute bacterial meningitis MSSA/MRSA, methicillin-sensitive/resistant

S. aureus

; MSSE/MRSE, methicillin-sensitive/resistant

S. epidermidis

.

Source

: Adapted from Ref. 42.

Meningitis and Its Mimics in Critical Care 149