Firstline - Clinical Decisions

Guideline Use

This guideline is not intended for the treatment of Severe Sepsis/Septic Shock

Utilize the Severe Sepsis/Septic Shock guidelines

Renal Impairment

Dose recommendations are based on patients with normal renal function. Refer to dosing in renal impairment

History of Multi-Drug Resistant Organisms

These guidelines may not be appropriate for patients with a history of multi-drug resistant organisms. Consider infectious disease consultation

Diagnostics

If Bacterial Meningitis Suspected

Empiric antibiotics should be started immediately (antimicrobial therapy should not be delayed if unable to obtain a Lumbar Puncture or while awaiting results of head CT)
ID consult is recommended

CSF Studies and Interpretation

CSF cytology, gram stain, and culture (culture yield <20% post antibiotics)
CSF HSV PCR if c/f viral encephalitis

Note: ventriculitis may demonstrate normal cytology

Management Considerations

Initiation of Empiric Therapy

Empiric therapy should not be unreasonably delayed pending results of head CT or lumbar puncture
If an LP is delayed, obtain blood cultures and initiate antimicrobial therapy

Infectious Diseases Consultation is strongly recommended

Treatment

Community-Onset Bacterial Meningitis

Post-Neurosurgery, Trauma without Skull Fracture, or CNS Shunt

Trauma with Basilar Skull Fracture

Brain Abscess

HSV Encephalitis Suspected

Deescalation

Pathogen-Directed Therapy

Additional Information

Guideline Disclaimer

These recommendations are meant to guide empiric therapeutic decision making and are not meant to replace sound clinical decision making. Definitive therapy should be based on culture and susceptibility reports

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