From the Guidelines
Infants with meningitis should be treated with amoxicillin/ampicillin/penicillin plus cefotaxime, or amoxicillin/ampicillin plus an aminoglycoside.
Antibiotic Choices
- For neonates <1 month old, the standard treatment is amoxicillin/ampicillin/penicillin plus cefotaxime, with dosages of cefotaxime 50 mg/kg q8h and ampicillin/amoxicillin 50 mg/kg q8h for age <1 week, and ampicillin 50 mg/kg q6h and cefotaxime 50 mg/kg q6-8h for age 1-4 weeks 1.
- Alternatively, amoxicillin/ampicillin plus an aminoglycoside can be used, with gentamicin 2.5 mg/kg q12h for age <1 week and 2.5 mg/kg q8h for age 1-4 weeks 1.
Considerations
- The choice of antibiotic should be guided by in vitro susceptibility test results and the patient's age and underlying conditions 1.
- Vancomycin and rifampicin may be added to the treatment regimen in certain cases, such as suspected Streptococcus pneumoniae or Neisseria meningitidis infection 1.
- Dexamethasone may be considered as an adjunctive treatment, but its use should be guided by the identification of the causative pathogen and the patient's clinical condition 1.
From the Research
Antibiotic Choices for Meningitis in Infants
- The choice of antibiotics for the treatment of meningitis in infants depends on various factors, including the causative pathogen, age of the infant, and antimicrobial susceptibility 2, 3, 4, 5.
- For empirical therapy of suspected bacterial meningitis, a third-generation cephalosporin (such as cefotaxime or ceftriaxone) plus ampicillin is recommended, especially for infants under 3 months of age 2, 3, 4.
- In cases where Gram-negative meningitis is suspected, a carbapenem may be considered as an alternative to a third-generation cephalosporin 2.
- For pneumococcal meningitis, combination treatment including a third-generation cephalosporin and vancomycin is recommended 4.
- Aminoglycosides, such as gentamicin, may be added to the treatment regimen in cases of Enterobacteriaceae infection, particularly in infants under 3 months of age 4, 5.
- The duration of antibiotic therapy for meningitis in infants is typically at least 7-10 days, depending on the causative pathogen and clinical response 3, 4, 5.
Specific Pathogens and Antibiotic Choices
- For Escherichia coli (E. coli) meningitis, a third-generation cephalosporin or a carbapenem may be effective 2.
- For Group B streptococcal (GBS) meningitis, penicillin or ampicillin is recommended 2, 3.
- For Listeria monocytogenes meningitis, ampicillin or penicillin plus an aminoglycoside is recommended 4, 5.
- For Haemophilus influenzae type b (Hib) meningitis, a third-generation cephalosporin or rifampicin may be effective 3, 4.
Limitations of Current Evidence
- There is a lack of high-quality evidence on the efficacy of antibiotic regimens for meningitis in young infants, particularly in the context of changing epidemiology and increasing antimicrobial resistance 6.
- Further research is needed to inform recommendations for optimal antibiotic regimens for meningitis treatment in this vulnerable population 6.