From the Guidelines
Meningitis treatment should always begin with prompt empiric antibiotic therapy, specifically a combination of vancomycin and a third-generation cephalosporin, along with dexamethasone administration to reduce inflammation and improve outcomes, as recommended by the most recent guidelines 1.
Treatment Regimens
The choice of antibiotic regimen depends on the patient's age and the likely causative organism.
- For neonates less than 1 month old, the recommended treatment is amoxicillin/ampicillin/penicillin plus cefotaxime, or amoxicillin/ampicillin plus an aminoglycoside 1.
- For patients between 1 month and 18 years old, cefotaxime or ceftriaxone plus vancomycin or rifampicin is recommended 1.
- For adults between 18 and 50 years old, cefotaxime or ceftriaxone plus vancomycin or rifampicin is also recommended, with adjustments for those with risk factors for Listeria monocytogenes 1.
Dexamethasone Administration
Dexamethasone should be administered before or with the first dose of antibiotics, at a dose of 10 mg IV every 6 hours, and can be continued for up to 4 days in cases of pneumococcal meningitis 1.
Monitoring and Supportive Care
Patients with meningitis require close monitoring for complications, including increased intracranial pressure, seizures, and electrolyte abnormalities, and should receive supportive care as needed.
Duration of Treatment
The duration of antibiotic treatment typically ranges from 7-14 days, depending on the identified pathogen 1.
Other Considerations
Therapeutic hypothermia and glycerol are not recommended as adjuvant therapies for community-acquired bacterial meningitis in adults 1.
From the FDA Drug Label
In the treatment of meningitis, it is recommended that the initial therapeutic dose be 100 mg/kg (not to exceed 4 grams). Thereafter, a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) is recommended. MENINGITIS Caused by Haemophilus influenzae, Neisseria meningitidis or Streptococcus pneumoniae
The recommended treatment for meningitis is 100 mg/kg (not to exceed 4 grams) as the initial dose, followed by a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) 2.
- The treatment is effective against Haemophilus influenzae, Neisseria meningitidis, and Streptococcus pneumoniae 2.
- Ampicillin may also be used to treat bacterial meningitis caused by E. coli, Group B Streptococci, and other Gram-negative bacteria, although the addition of an aminoglycoside may be necessary to increase its effectiveness 3.
From the Research
Treatment Options for Meningitis
- Ceftriaxone, a cephalosporin with an extended half-life and excellent antibacterial activity, has been used to treat bacterial meningitis, given as a single daily intravenous dose of 100 mg/kg on day one, followed by 80 mg/kg daily 4.
- The use of empiric vancomycin plus a third-generation cephalosporin for suspected bacterial meningitis has been recommended since 1997, and vancomycin should still be included as empiric therapy for bacterial meningitis 5.
- Ceftriaxone or cefotaxime is now the preferred drug for bacterial meningitis caused by H. influenzae, meningococci, and pneumococci, and it reaches a high bactericidal titer in the cerebrospinal fluid and persists at the site of infection longer than any other beta-lactam antibiotic 6.
Antibiotic Therapy
- The choice of empirical antimicrobial therapy is based on the patient's age and underlying disease status; once the infecting pathogen is isolated, antimicrobial therapy can be modified for optimal treatment 7.
- The emergence of antibiotic-resistant bacterial strains in recent years has necessitated the development of new strategies for empiric antimicrobial therapy for bacterial meningitis 7, 8.
- Successful treatment of bacterial meningitis requires knowledge of epidemiology, including prevalence of antimicrobial resistant pathogens, pathogenesis of meningitis, pharmacokinetics, and pharmacodynamics of antimicrobial agents 7.
Patient Management
- The management approach to patients with suspected or proven bacterial meningitis includes emergent cerebrospinal fluid analysis and initiation of appropriate antimicrobial and adjunctive therapies 7, 8.
- In adults, ceftriaxone is effective therapy for presumed bacterial meningitis but must be combined with ampicillin initially, since L. monocytogenes meningitis cannot be excluded in most cases until CSF culture results are available 6.