Typhoid Meningitis Treatment
For typhoid meningitis, treat with ceftriaxone 50-60 mg/kg/day IV divided into two doses (or as a single daily dose) for 5-8 days, as this regimen has demonstrated rapid clinical response and successful outcomes in bacteremic typhoid fever with CNS involvement. 1
Primary Treatment Regimen
- Ceftriaxone is the drug of choice for typhoid meningitis, administered at 50-60 mg/kg/day IV in two divided doses, with treatment duration of 5-8 days being adequate for cure 1
- The mean period of defervescence is approximately 4 days when medical complications are absent 1
- Both peak and trough ceftriaxone concentrations achieve levels well above the MIC for Salmonella typhi strains, ensuring adequate CNS penetration 1
Dosing Considerations by Age
- For pediatric patients and young adults with meningitis: Administer ceftriaxone 50 mg/kg IV every 12 hours 2
- For adults: Use ceftriaxone 2g IV every 12 hours, which is the standard meningitis dosing 3, 4
- For neonates: Administer IV doses over 60 minutes (not 30 minutes) to reduce risk of bilirubin encephalopathy 5
Treatment Duration and Monitoring
- 5-8 days of therapy is sufficient for uncomplicated typhoid meningitis cases that respond appropriately 1
- If the patient remains febrile beyond expected defervescence (4 days), investigate for medical complications or treatment failure 1
- Monitor for relapse during the 1-8 month post-treatment period, though relapses are uncommon with adequate ceftriaxone therapy 1
Critical Clinical Pitfalls
- Do not use first-generation cephalosporins - they achieve inadequate CSF concentrations and have high failure rates in meningitis 6
- Avoid calcium-containing IV solutions when administering ceftriaxone, as precipitation can occur; flush lines thoroughly between infusions if sequential administration is necessary 5
- Exclude concomitant complications (such as brain abscess, persistent bacteremia, or immunocompromise) that may require extended therapy beyond the standard 5-8 day course 1
Alternative Considerations
- While chloramphenicol has historically been used for typhoid fever, ceftriaxone offers advantages including rapid clinical response, shorter treatment course, and lack of serious adverse reactions 1
- The single daily dosing option (50-60 mg/kg once daily) may be considered for patient convenience, though the divided twice-daily regimen has more extensive documentation 1
Adjunctive Therapy
- Consider dexamethasone if there is significant cerebral edema or increased intracranial pressure, though this is based on general bacterial meningitis principles rather than typhoid-specific data 3, 7
- Ensure adequate supportive care including fluid management and monitoring for complications of typhoid fever (intestinal perforation, myocarditis) 1