Community Acquired Meningitis

Initial Treatment

  • Option for bacterial meningitis but use remains controversial.

  • Benefit may be dependent on age, pathogen and severity of presentation.

  • In adult patients with S. pneumoniae meningitis it has shown to decrease mortality and hearing loss.

  • Use NOT recommended if antimicrobial therapy has already been initiated.

  • Reassess continuation of dexamethasone after pathogen identification - DISCONTINUE if Streptococcus pneumoniae meningitis ruled out.



  • Target trough level of 10-15 mg/L

  • Dose adjustment required in renal dysfunction.

  • Consider capping the loading dose at a maximum of 3,000 mg and maintenance doses at a maximum of 2,000 mg.

  • Give AFTER first dose of ceftriaxone, and only continue if C&S results positive for ceftriaxone resistant S. pneumoniae.


  • age greater than 50

    • immunocompromised
    • alcohol abuse
    • pregnancy
    • debilitating illness

Additional Information

  • Listeria monocytogenes not covered by cephalosporins and not adequately covered by vancomycin
  • Do NOT delay antimicrobial therapy if LP and/or neuroimaging cannot be completed expediently
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