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Infection
Meningitis Possible therapeutic alternatives
Empiric therapy (Age < 50 years) Common pathogens
(Cefotaxime 2 grams IVPB q4h or Ceftriaxone 2 grams IVPB q12h) + dexamethasone (0.4mg/kg q12h x 2 days given 30 minutes prior to antibiotics) + Vancomycin 1 gram IVPB q12h (may need higher doses).   May also add Rifampin 600mg po qd or 300mg po bid.
If severe penicillin allergy:
Chloramphenicol 1g IV q6h + Vancomycin +/- Rifampin.
Age > 50 years or alcoholism or other debilitating disease. Common pathogens
Ampicillin 2 grams IVPB q4h + [Ceftriaxone 2 grams IVPB q12h or Cefotaxime 2 grams IVPB q4-6h]  + dexamethasone.  
Ampicillin 2g IV q4h + vancomycin 1g IV q12h plus either  [Cefotaxime 2g IV q4-6h or Ceftriaxone 2g IV q12-24h ]
If severe penicillin allergy:
 Vancomycin 1 gram IVPB q12h + Bactrim 15-20 mg/kg/day in 4 divided doses pending culture results. or  
[Chloramphenicol 1g IV q6h + vancomycin +/- rifampin 300mg PO or IV bid]
Trauma or post neurosurgery Common pathogens
Vancomycin 1 gram IVPB q6-12h + Ceftazidime 2 grams IVPB q8h.  // If gram negative bacilli are suspected add Gentamycin IVPB +/- intrathecally.
Impaired cellular immunity Common pathogens
Ampicillin 2 grams IVPB q4h + Ceftazidime 2 grams IVPB q8h.  //  //
If severe penicillin allergy:
Bactrim 15-20mg/kg/day in 4 divided doses. May add Gentamicin. 
If Listeria present: cephalosporins are not effective.
N.meningitidis confirmed  
Penicillin G  4 million units IVPB q4h. 
If severe penicillin allergy:
Chloramphenicol 4 to 6 grams/day in 4 divided doses.

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Meningies

References - Infectious Disease Section
Infectious Disease References

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