From the Guidelines
Vancomycin, Amikacin, and Ceftriaxone doses for a 65-kilogram male patient with meningitis in the ICU are as follows:
- Vancomycin: 15-20 mg/kg IV every 8-12 hours, with a target trough concentration of 15-20 μg/mL 1
- Amikacin: 10 mg/kg IV every 8 hours, for patients aged 1 month to 18 years, or 10-15 mg/kg IV every 8 hours for patients aged 1-4 weeks 1
- Ceftriaxone: 2 g IV every 12 hours, or 50 mg/kg IV every 12 hours (maximum 2 g every 12 hours) for patients aged 1 month to 18 years, or 2 g IV every 12 hours for patients aged >18 and <50 years 1
Key Considerations
- The doses of Vancomycin, Amikacin, and Ceftriaxone may vary depending on the patient's age, weight, and renal function.
- The treatment duration for meningitis is typically 10-14 days, but may be extended to 21 days in certain cases, such as Listeria monocytogenes infection or if the patient is not responding to treatment 1.
- Serum trough concentrations of Vancomycin should be monitored to ensure target concentrations are achieved, especially in patients with normal renal function 1.
- Amikacin is not typically used as a first-line treatment for meningitis, but may be considered in certain cases, such as when there is a high suspicion of an extended-spectrum beta-lactamase (ESBL) organism 1.
- Ceftriaxone is a commonly used antibiotic for the treatment of meningitis, and its dose and frequency may vary depending on the patient's age and weight 1.
From the Research
Vancomycin Dosing
- The optimal loading dose of vancomycin for a 65-kilogram male patient is 25 mg/kg infused over 90 minutes to reach the target range of 20-30 mg/L 2.
- The optimal maintenance dose of vancomycin for a patient with low renal function (CLCr < 45 mL/min) is 1000-1500 mg/day, while for a patient with augmented renal clearance (CLCr > 130 mL/min), the dose should be up to 3500 mg/day or even 4500 mg/day to achieve adequate exposure 2.
- A simplified method for initiating vancomycin therapy involves administering an average dose of 8.3 mg/kg lean body weight, with the dosing interval predicted by the patient's estimated creatinine clearance 3.
Ceftriaxone Dosing
- High-dose ceftriaxone administration schemes for treating meningitis should be adapted to the estimated glomerular filtration rate (eGFR) and weight, with a dosing nomogram developed to determine the optimal dosage allowing achievement of targeted plasma trough concentrations 4.
- Ceftriaxone can be administered at a dose of 75 to 100 mg/kg of body weight/day without an upper limit, with a twice-daily regimen 4.
- A dose of 80 mg/kg of ceftriaxone once daily has been shown to be effective in treating meningitis, with cerebrospinal fluid concentrations 8- to more than 100-fold greater than the 90% MBCs against relevant pathogens 5.
Amikacin Dosing
- There is no direct evidence provided for the dosing of amikacin in the treatment of meningitis.
Combination Therapy
- Combination regimens of ceftriaxone, vancomycin, and rifampicin have been shown to be effective in treating experimental multidrug-resistant pneumococcal meningitis, with the triple-drug combination showing comparable therapeutic efficacy to the double-drug combination of ceftriaxone and rifampicin 6.