What is the treatment for meningitis?

From the Guidelines

The treatment for meningitis should begin immediately with empiric antibiotic therapy, and for bacterial meningitis, the recommended regimen includes ceftriaxone (2g IV every 12 hours) plus vancomycin (15-20 mg/kg IV every 8-12 hours) for adults, along with dexamethasone (10 mg IV every 6 hours) to reduce inflammation and improve outcomes, as suggested by the most recent guidelines 1.

Key Considerations

• The choice of antibiotic regimen depends on the patient's age and underlying health conditions, with specific recommendations for neonates, children, and adults 1.
• Dexamethasone should be started on admission, either shortly before or simultaneously with the antibiotics, and continued for 4 days if pneumococcal meningitis is confirmed or thought probable 1.
• The treatment duration typically ranges from 7-21 days depending on the causative organism, and supportive care is essential for all types of meningitis, including fluid management, fever control, seizure prevention, and monitoring for increased intracranial pressure.

Adjunctive Treatments

• Therapeutic hypothermia is not recommended for adults with bacterial meningitis, as it has been shown to increase mortality rates 1.
• Glycerol is not recommended as adjuvant therapy for community-acquired bacterial meningitis in adults 1.
• Intracranial pressure (ICP)-based treatment strategies, including drainage of CSF by means of external lumbar or ventricular drains, mannitol, and methylprednisolone, should not be used for routine care of meningitis patients until RCTs have shown additional value of these potentially harmful treatments 1.

Patient-Specific Considerations

• For patients with risk factors for Listeria monocytogenes, such as diabetes mellitus, use of immunosuppressive drugs, cancer, and other conditions causing immunocompromise, the recommended regimen includes ceftriaxone (2g IV every 12 hours) plus vancomycin (15-20 mg/kg IV every 8-12 hours) plus amoxicillin/ampicillin/penicillin G 1.
• For patients with suspected meningitis, it is essential to start treatment promptly, as delays can lead to permanent neurological damage or death 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. Ceftriaxone for Injection is indicated for the treatment of the following infections when caused by susceptible organisms: ... MENINGITIS Caused by Haemophilus influenzae, Neisseria meningitidis or Streptococcus pneumoniae Bacterial Meningitis caused by E. coli, Group B Streptococci, and other Gram-negative bacteria (Listeria monocytogenes, N. meningitidis).

The treatment for meningitis includes:

• Ceftriaxone: initial dose of 100 mg/kg (not to exceed 4 grams), followed by a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) 2
• Ampicillin: may be used to treat bacterial meningitis caused by E. coli, Group B Streptococci, and other Gram-negative bacteria, and the addition of an aminoglycoside may increase its effectiveness against Gram-negative bacteria 3 Key points to consider:
• The choice of antibiotic depends on the causative organism and its susceptibility to the antibiotic.
• It is essential to consider local epidemiology and susceptibility patterns when selecting empiric therapy.
• The treatment should be started as soon as possible, and the patient's condition should be closely monitored. 2

From the Research

Treatment for Meningitis

The treatment for meningitis typically involves the use of antibiotics, with the specific type and dosage depending on the cause of the infection.

• Ceftriaxone is a commonly used antibiotic for the treatment of bacterial meningitis, particularly for infections caused by H. influenzae, meningococci, and pneumococci 4, 5, 6.
• Ceftriaxone has been shown to be effective in treating bacterial meningitis, with high bactericidal titers in the cerebrospinal fluid and a low risk of side effects 5, 6.
• Vancomycin is another antibiotic that may be used to treat bacterial meningitis, particularly in cases where the infection is caused by resistant strains or unusual organisms 7.
• The choice of antibiotic and dosage may depend on the age of the patient, with ceftriaxone being effective in infants and children, but not recommended in neonates due to concerns about bilirubin displacement 4.
• Combination therapy with multiple antibiotics may be used in some cases, such as when the infection is caused by multiple organisms or when the patient has a history of antibiotic resistance 8.
• The duration of treatment for meningitis typically ranges from 10 to 14 days, depending on the cause of the infection and the patient's response to treatment 8.

Antibiotic Dosage and Administration

• Ceftriaxone is typically administered at a dose of 100 mg/kg per day, with some studies suggesting that once-daily dosing may be effective 5, 6.
• Vancomycin is typically administered at a dose of 60 mg/kg per day, with the possibility of adding intrathecal therapy if the response to intravenous administration is unsatisfactory 7.
• The choice of antibiotic and dosage should be guided by the results of cerebrospinal fluid cultures and susceptibility testing, as well as the patient's clinical response to treatment 8.

Special Considerations

• In cases where pneumococcal meningitis cannot be ruled out, combination treatment with cefotaxim or ceftriaxone and vancomycine may be necessary 8.
• For Neisseria meningitidis or Haemophilus influenzae meningitis, a simple treatment with third generation cephalosporin may be used 8.
• Aminoglycosides must be added in case of Enterobacteriacae, mainly before 3 months of age 8.