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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 or 0.15 mg/kg IV q6h  x 2 days given 30 minutes prior to antibiotics)

+

Vancomycin
1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)   

May also add Rifampin 600mg po qd or 300mg po bid.
Alternative:
meropenem 2 gram IV q8h
+ 
Vancomycin 1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)  
+ 
Dexamethasone (0.15 mg/kg IV q6h  x 2 to 4 days given 30 minutes prior to antibiotics)
Meropenem - Renal dosing

Creatinine Clearance

(mL/min)
Dose (dependent on type of infection) Dosing Interval
> 50 Recommended dose (2 g meningitis) Every 8 hours
> 25-50 Recommended dose Every 12 hours
10-25 One-half recommended dose Every 12 hours
< 10 One-half recommended dose Every 24 hours
If severe penicillin allergy:
Chloramphenicol 1g IV q6h (12.5 mg/kg IV q6h (max. 4 gm/day)
+

Vancomycin
1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)    
+/-
Rifampin
.
Age > 50 years or alcoholism or other debilitating disease. Common pathogens
Ampicillin 2g IV q4h
+
 
Vancomycin 1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)  
+ 
[Cefotaxime 2g IV q4-6h or Ceftriaxone 2g IV q12-24h ]
+
Dexamethasone (0.15 mg/kg IV q6h  x 2 to 4 days given 30 minutes prior to antibiotics)
Alternative:
meropenem 2 gram IV q8h
+ 
Vancomycin 1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)  
+ 
Dexamethasone (0.15 mg/kg IV q6h  x 2 to 4 days given 30 minutes prior to antibiotics)



Meropenem - Renal dosing

Creatinine Clearance

(mL/min)
Dose (dependent on type of infection) Dosing Interval
> 50 Recommended dose (2 g meningitis) Every 8 hours
> 25-50 Recommended dose Every 12 hours
10-25 One-half recommended dose Every 12 hours
< 10 One-half recommended dose Every 24 hours
If severe penicillin allergy:
Vancomycin 1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)  
+   
Bactrim 15-20 mg/kg/day in 4 divided doses pending culture results. or  
[Chloramphenicol 1g IV q6h (12.5 mg/kg IV q6h (max. 4 gm/day)
+
 
Vancomycin
1 gram  ivpb q12h (patient-specific dosing required - target trough 15-20 mcg/ml)  
+/-   
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 1g IV q6h (12.5 mg/kg IV q6h (max. 4 gm/day)

Images

Meningies

References - Infectious Disease Section

Infectious Disease References

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.
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