What is the treatment for bacterial meningitis?

From the Guidelines

Bacterial meningitis requires immediate hospitalization and treatment with intravenous antibiotics, and the standard initial treatment includes a combination of vancomycin and a third-generation cephalosporin such as ceftriaxone or cefotaxime, with dexamethasone given before or with the first dose of antibiotics to reduce inflammation and improve outcomes. The choice of antibiotics depends on the patient's age and risk factors, with the most recent guideline from 1 providing recommendations for different patient groups. For example, for adults aged 18-50 years, the recommended treatment is ceftriaxone (2g IV every 12 hours) or cefotaxime (2g IV every 4-6 hours) plus vancomycin (10-20 mg/kg IV every 8-12 hours).

The use of dexamethasone is supported by the guideline from 1, which recommends starting dexamethasone (10 mg IV) 6 hourly on admission, either shortly before or simultaneously with the antibiotics. The guideline also advises to continue dexamethasone for 4 days if pneumococcal meningitis is confirmed or thought probable, but to stop it if another cause of meningitis is confirmed or thought probable.

Supportive care, including fluid management, seizure control, and monitoring for increased intracranial pressure, is essential in the treatment of bacterial meningitis. Close contacts may need prophylactic antibiotics, especially for meningococcal or Haemophilus influenzae infections. The treatment of bacterial meningitis is life-threatening and requires an aggressive approach, with mortality rates of 15-30% without prompt treatment, as highlighted in the guideline from 1.

Key points to consider in the treatment of bacterial meningitis include:

• Immediate hospitalization and treatment with intravenous antibiotics
• Use of dexamethasone to reduce inflammation and improve outcomes
• Choice of antibiotics based on patient age and risk factors
• Supportive care, including fluid management and monitoring for increased intracranial pressure
• Prophylactic antibiotics for close contacts, especially for meningococcal or Haemophilus influenzae infections.

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 Bacterial Meningitis caused by E. coli, Group B Streptococci, and other Gram-negative bacteria (Listeria monocytogenes, N. meningitidis).

The treatment for bacterial meningitis is ceftriaxone or ampicillin.

• Ceftriaxone should be administered at an 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 also be used, especially for meningitis caused by E. coli, Group B Streptococci, and other Gram-negative bacteria 3.

From the Research

Treatment Overview

The treatment for bacterial meningitis typically involves the use of antibiotics, with the specific choice of antibiotic depending on the suspected or confirmed cause of the infection.

• Ceftriaxone or cefotaxime is often the preferred drug for bacterial meningitis caused by H. influenzae, meningococci, and pneumococci 4.
• 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 4.
• Initial empiric therapy for community-acquired bacterial meningitis should include a combination of third-generation cephalosporin (cefotaxime or ceftriaxone) and vancomycin, with ampicillin added if the patient has predisposing factors for infection with Listeria monocytogenes 5.

Adjunctive Therapy

Adjunctive therapy, such as the use of corticosteroids, may be considered in certain cases of bacterial meningitis.

• Dexamethasone has been shown to inhibit the synthesis of inflammatory cytokines, which can contribute to the pathophysiology of bacterial meningitis 5.
• However, the use of dexamethasone in bacterial meningitis is not without controversy, and its benefits and risks must be carefully considered, particularly in cases of meningitis caused by antibiotic-resistant pneumococci 6.

Antibiotic Resistance

The increasing prevalence of antibiotic-resistant bacteria, such as penicillin-resistant pneumococci, has important implications for the treatment of bacterial meningitis.

• Vancomycin should be included as empiric therapy for bacterial meningitis, even in areas where the prevalence of ceftriaxone-nonsusceptible pneumococcal meningitis is low 7.
• The use of antibiotic combinations, such as ceftriaxone and vancomycin, may be necessary to ensure effective treatment of bacterial meningitis caused by antibiotic-resistant bacteria 6.