What is the treatment for bacterial meningitis?

From the Guidelines

To treat bacterial meningitis, immediately administer high-dose intravenous antibiotics, with the recommended initial regimen being Ceftriaxone 2g IV every 12 hours or Cefotaxime 2g IV every 4-6 hours, plus Vancomycin 15-20 mg/kg IV every 8-12 hours, and consider adding Ampicillin 2g IV every 4 hours for patients >50 years or immunocompromised, as suggested by the ESCMID guideline 1. The choice of antibiotics depends on the patient's age and underlying health conditions. For example, neonates <1 month old should receive Amoxicillin/ampicillin/penicillin plus cefotaxime, or amoxicillin/ampicillin plus an aminoglycoside, while patients between 1 month to 18 years should receive Cefotaxime or ceftriaxone plus vancomycin or rifampicin 1. Some key points to consider when treating bacterial meningitis include:

• Starting treatment as soon as possible, ideally within 1 hour of presentation, even before confirmatory tests are complete 1, 2, 3
• Continuing treatment for 7-21 days, depending on the causative organism and clinical response 1, 2, 3
• Administering dexamethasone 0.15 mg/kg IV every 6 hours for 2-4 days, starting before or with the first antibiotic dose, to reduce inflammation and potential neurological complications, but considering stopping dexamethasone if pathogens other than S. pneumoniae or H. influenzae are identified 1, 2
• Providing supportive care, including fluid management and close monitoring of intracranial pressure 1, 2, 3 It's also important to note that therapeutic hypothermia is not recommended for adults with bacterial meningitis, as it has been shown to increase mortality rates in this population 1, 2. Additionally, glycerol is not recommended as adjuvant therapy for community-acquired bacterial meningitis in adults 2.

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. The usual duration of therapy is 7 to 14 days

• Treatment for bacterial meningitis: The recommended dose of ceftriaxone is 100 mg/kg (not to exceed 4 grams) as an initial therapeutic dose, followed by a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) for 7 to 14 days 4.

From the Research

Treatment Overview

The treatment for bacterial meningitis typically involves immediate antibiotic therapy, even before the results of cerebrospinal fluid (CSF) culture and antibiotic sensitivity are available 5. The goal is to reduce death and disability by starting effective treatment as soon as possible.

Antibiotic Therapy

• Third-generation cephalosporins, such as ceftriaxone or cefotaxime, are commonly used to treat bacterial meningitis 5, 6.
• In some cases, conventional antibiotics like penicillin or ampicillin-chloramphenicol may be used as alternatives, especially in low-income countries where third-generation cephalosporins are not available 5.
• The choice of antibiotic therapy may depend on the suspected causative organism and the patient's age, with combination treatment including cefotaxim and vancomycine being the standard first-line therapy for infants and children 6.
• New antibiotics, such as fluoroquinolones, may also be used to treat bacterial meningitis, especially in cases where the bacteria are resistant to other antibiotics 7, 8.

Adjunctive Therapies

• Adjunctive anti-inflammatory therapies, such as dexamethasone, may be used to improve outcomes in patients with bacterial meningitis, although their effectiveness is still controversial 7, 8.
• Other adjunctive therapies, such as glycerol, paracetamol, and induction of hypothermia, are being tested further to determine their effectiveness in treating bacterial meningitis 7.

Treatment Duration and Monitoring

• The duration of antibiotic therapy for bacterial meningitis typically ranges from 10 to 14 days, depending on the causative organism and the patient's response to treatment 6, 8.
• Patients with bacterial meningitis require close monitoring for complications, such as neurological and non-neurological complications, and may need to be treated in an intensive care unit with neurological expertise and interdisciplinary support 9.