From the Guidelines
Antibiotics should be started immediately, ideally within one hour of arrival, in patients with suspected meningitis, as recommended by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) guideline 1. The choice of antibiotics should be based on the patient's age, risk factors, and local resistance rates of pneumococci. For empiric therapy in adults, administer ceftriaxone 2g IV every 12 hours, as recommended by the UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1. If the patient has been to a country where penicillin-resistant pneumococci are prevalent, add vancomycin 15-20 mg/kg IV every 12 hours 1. Rapid antibiotic administration is critical because bacterial meningitis has high mortality and delay in treatment increases the risk of poor outcomes. Some key points to consider when treating suspected meningitis include:
- Obtaining blood cultures before starting antibiotics
- Not delaying treatment to perform a lumbar puncture or imaging
- Considering the use of dexamethasone to reduce inflammation and improve outcomes, particularly in pneumococcal meningitis 1
- Evaluating surviving patients for hearing loss and providing pneumococcal vaccination to prevent recurrences 1
From the FDA Drug Label
1.3 Bacterial Meningitis (Pediatric Patients 3 Months of Age and Older Only) The FDA drug label does not answer the question.
From the Research
Timing of Antibiotic Administration in Suspected Meningitis
- The administration of antibiotics in suspected meningitis cases should be prompt, as delayed initiation can worsen mortality 2.
- Antibiotics should be administered within 30 minutes after admission to the hospital 3.
- Empiric antibiotics should be directed toward the most likely pathogens and should be adjusted by patient age and risk factors 2.
- Treatment should be started promptly in cases where transfer, imaging, or lumbar puncture may slow a definitive diagnosis 2.
Choice of Antibiotics
- Third-generation cephalosporins, such as ceftriaxone or cefotaxime, are commonly used to treat bacterial meningitis 4, 5, 6.
- These antibiotics have been shown to have good cerebrospinal fluid penetration and antimicrobial efficacy in cases of bacterial meningitis in children 6.
- However, the choice of antibiotic may depend on the suspected causative organism and local resistance patterns 4, 5.
Importance of Prompt Treatment
- Prompt recognition and treatment of bacterial meningitis are crucial to reduce mortality and improve outcomes 3, 2.
- Delayed initiation of antibiotics can worsen mortality, and treatment should be started promptly, even before the results of cerebrospinal fluid culture and antibiotic sensitivity are available 5, 2.