From the Guidelines
Infants with meningitis should be treated with ampicillin or amoxicillin plus cefotaxime, or ampicillin or amoxicillin plus an aminoglycoside.
Recommended Antibiotics for Meningitis in Infants
The choice of antibiotics depends on the age of the infant and the suspected causative pathogen.
- For neonates <1 month old, the recommended treatment is:
- Amoxicillin/ampicillin/penicillin plus cefotaxime, with dosages of cefotaxime 50 mg/kg q8h, ampicillin/amoxicillin 50 mg/kg q8h, and gentamicin 2.5 mg/kg q12h for age <1 week, and ampicillin 50 mg/kg q6h, cefotaxime 50 mg/kg q6-8h, gentamicin 2.5 mg/kg q8h, tobramycin 2.5 mg/kg q8h, and amikacin 10 mg/kg q8h for age 1-4 weeks 1.
- For infants 1 month to 18 years old, the recommended treatment is cefotaxime or ceftriaxone plus vancomycin or rifampicin, with dosages of vancomycin 10-15 mg/kg q6h, rifampicin 10 mg/kg q12h, cefotaxime 75 mg/kg q6-8h, and ceftriaxone 50 mg/kg q12h (maximum 2 g q12h) 1.
Important Considerations
It is essential to note that the use of adjunctive dexamethasone in the treatment of bacterial meningitis is recommended, but its discontinuation should be considered if pathogens other than Streptococcus pneumoniae or Haemophilus influenzae are identified 1. Additionally, the choice of antibiotics should be guided by local antibiograms and susceptibility testing, and the treatment regimen should be adjusted accordingly 1.
From the Research
Recommended Antibiotics for Meningitis in Infants
The following antibiotics are recommended for the treatment of meningitis in infants:
- Ampicillin and gentamicin, with third-generation cephalosporins reserved for cases where meningitis is suspected 2
- A third-generation cephalosporin (plus ampicillin for at least the first month), potentially substituting a carbapenem for the cephalosporin if there is evidence for Gram-negative meningitis 3
- Cefotaxime or ceftriaxone and vancomycin for infants and children older than 1 month of age 4
Considerations for Antibiotic Regimens
When choosing an antibiotic regimen for meningitis in infants, consider the following:
- The causative agents of serious bacterial infection in young infants, such as Escherichia coli and group B Streptococcus (GBS) 3
- The potential for antimicrobial resistance, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus sp., and penicillin-resistant Streptococcus pneumoniae 2
- The need for prompt cerebrospinal fluid collection to guide appropriate therapy 2
Efficacy of Antibiotic Regimens
The efficacy of antibiotic regimens for meningitis in young infants is not well established, with limited data from randomized controlled trials 5