Treatment of Klebsiella Meningitis in Children
For Klebsiella meningitis in children, initiate empiric treatment with meropenem at 40 mg/kg every 8 hours intravenously, as this carbapenem provides optimal CNS penetration and coverage against both susceptible and resistant Klebsiella strains. 1, 2
Empiric Antibiotic Selection
Age-Based Initial Therapy
Children ≥3 months: Start with meropenem 40 mg/kg IV every 8 hours as the preferred agent, given the increasing prevalence of extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae 1, 2, 3
Infants <3 months: Administer cefotaxime plus ampicillin or amoxicillin to cover both gram-negative organisms and Listeria 4
Rationale for Meropenem as First-Line
Meropenem demonstrates 78% clinical cure rates in pediatric bacterial meningitis, with proven efficacy against Klebsiella species 1
ESBL-producing Klebsiella accounts for approximately 27-30% of post-neurosurgical meningitis cases, making third-generation cephalosporins unreliable 2
Meropenem is the drug of choice for ESBL-producing organisms with excellent CSF penetration 3
Targeted Therapy Based on Susceptibility
For Susceptible Klebsiella (Non-ESBL)
Third-generation cephalosporins remain appropriate for primary community-acquired Klebsiella meningitis when susceptibility is confirmed 2
Continue cefotaxime or ceftriaxone if organism proves susceptible and clinical improvement occurs 4
For Resistant Klebsiella (ESBL or Carbapenem-Resistant)
For carbapenem-resistant Klebsiella pneumoniae (CRKP): Consider combination therapy with levofloxacin plus aztreonam or meropenem plus high-dose fosfomycin 5, 3
Alternative combinations include polymyxin, tigecycline, or aminoglycosides based on susceptibility patterns 5
Treatment Duration and Monitoring
Continue antibiotics for minimum 14-21 days for gram-negative meningitis (longer than the 7-day course for meningococcal disease) 4
Repeat lumbar puncture if clinical progress is unsatisfactory or diagnostic uncertainty persists 4
Adjunctive Corticosteroid Therapy
Administer dexamethasone 0.15 mg/kg IV every 6 hours for 4 days when treating empiric bacterial meningitis of unknown etiology, given with or within 24 hours of first antibiotic dose 4
This recommendation applies to empiric treatment before pathogen identification 4
Supportive Care and Complications
Fluid Management
Avoid aggressive fluid resuscitation unless signs of septic shock are present (unlike meningococcal septicemia) 4
If shock develops, administer 20 mL/kg boluses of isotonic crystalloid up to 60 mL/kg total with reassessment after each bolus 4
Intensive Care Considerations
Transfer to pediatric intensive care if patient deteriorates despite appropriate treatment 4
Monitor for complications including subdural hygroma/empyema, hydrocephalus, venous sinus thrombosis, and cerebral infarctions 4, 6
Neuroimaging
- Obtain MRI (preferred) or CT if neurological deterioration occurs, as Klebsiella meningitis frequently causes vascular complications 4, 6
Post-Treatment Follow-Up
Perform hearing evaluation during admission using otoacoustic emission screening in children 4
Conduct formal audiometry at follow-up (6-12 months post-treatment) as hearing loss occurs in 5-35% of bacterial meningitis survivors 4
Assess for neuropsychological sequelae including cognitive deficits, motor deficits, seizures, and behavioral problems, which occur in approximately one-third of survivors 4
Critical Clinical Pearls
Klebsiella meningitis carries 48.5% mortality for K. pneumoniae and requires aggressive early treatment 7
Post-neurosurgical meningitis has higher rates of resistant organisms; empiric meropenem is mandatory 2
Primary community-acquired Klebsiella meningitis is associated with diabetes mellitus, liver cirrhosis, and male gender 7
Poor prognostic factors include age >60 years (less relevant in pediatrics), diabetes, bacteremia, and severe neurological deficits at presentation 7