What is the current treatment for pediatric meningitis in the Chicago area?

From the Guidelines

The current treatment for pediatric meningitis in the Chicago area involves prompt administration of empiric antibiotics, with the standard regimen including ceftriaxone plus vancomycin for children over 1 month old, and ampicillin added for those under 3 months to cover Listeria, as recommended by the most recent guidelines 1.

Treatment Regimens

The treatment regimens are as follows:

• For neonates <1 month old: ampicillin/ampicillin/penicillin plus cefotaxime, or ampicillin/ampicillin plus an aminoglycoside, with dosages as specified in the guidelines 1
• For children 1 month to 18 years: cefotaxime or ceftriaxone plus vancomycin or rifampicin, with dosages as specified in the guidelines 1

Adjunctive Treatments

Adjunctive treatments may include:

• Dexamethasone, which may be administered before or with the first dose of antibiotics to reduce inflammation and potential neurological complications, particularly for Haemophilus influenzae type B meningitis, but should be discontinued if Listeria is identified 1
• Supportive care, including fluid management, antipyretics, anticonvulsants if seizures occur, and close monitoring of neurological status

Important Considerations

It is crucial to note that:

• Early treatment is essential to reduce morbidity and mortality rates in pediatric meningitis cases
• The decision to stop or continue dexamethasone can be made on an individual basis for pathogens other than S. pneumoniae or H. influenzae 1
• Other adjunctive treatments, such as intracranial pressure-based treatment and therapeutic hypothermia, are not recommended for routine care until further research is conducted 1

From the FDA Drug Label

For 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 current treatment for pediatric meningitis is ceftriaxone (IV) with an initial dose of 100 mg/kg (not to exceed 4 grams) and a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) 2.

• The dosage may be administered once a day (or in equally divided doses every 12 hours).
• The usual duration of therapy is 7 to 14 days.

From the Research

Current Treatment for Pediatric Meningitis

The current treatment for pediatric meningitis involves the use of antibiotics, with the specific type and duration of treatment depending on the causative pathogen and the patient's condition.

• The optimal duration of antibiotic treatment for bacterial meningitis in children is not well-established, but a meta-analysis found no differences in outcomes between shorter (up to 7 days) and longer (10 days or more) courses of treatment 3.
• Combination therapy with cefotaxime or ceftriaxone and vancomycin is commonly used as first-line treatment, especially if pneumococcal meningitis is suspected 4.
• Ceftriaxone is a commonly used antibiotic for the treatment of bacterial meningitis in children, and it can be administered intramuscularly in patients with good peripheral perfusion 5, 6.
• The choice of antibiotic and duration of treatment may vary depending on the specific pathogen and the patient's response to treatment, with second-line therapy adapted according to clinical and bacteriological response 4.

Antibiotic Options

Several antibiotics have been shown to be effective in the treatment of pediatric meningitis, including:

• Ceftriaxone, which has been shown to be effective against a range of pathogens, including Streptococcus pneumoniae, Haemophilus influenzae, and Neisseria meningitidis 3, 5, 7, 6.
• Cefotaxime, which is also effective against these pathogens and is often used in combination with vancomycin as first-line treatment 4, 7.
• Other cephalosporins, such as ceftizoxime and ceftazidime, which have also been shown to be effective in the treatment of meningitis 7.

Treatment Duration and Route of Administration

The duration of antibiotic treatment for pediatric meningitis typically ranges from 7 to 14 days, depending on the specific pathogen and the patient's response to treatment 3, 4.

• Intravenous administration is commonly used, but intramuscular administration of ceftriaxone has been shown to be effective in patients with good peripheral perfusion 5, 6.