Community Acquired Meningitis
>50/Immunocompromised/Alcoholism

>50/Immunocompromised/Alcoholism

Note

Consult specialist/Infectious Diseases is recommended

Usual Pathogens

At HGH, resistance to penicillin is 0%

First Line Treatment

AND

Ensure pharmacy consult for dosing

  • Dosing recommendations are based on 70kg patient with normal renal function; (recommended dose 15-20 mg/kg/dose unless otherwise stated)
  • Please contact pharmacy for patients requiring vancomycin or aminoglycoside monitoring

AND

For Listeria

+/-

Dexamethasone 0.15 mg/kg IV q6h x 2-4 days

Before or at start of antimicrobial therapy

Second Line Treatment

If β-lactam allergy considered very severe contact TOH ID

AND

Ensure pharmacy consult for dosing

  • Dosing recommendations are based on 70kg patient with normal renal function; (recommended dose 15-20 mg/kg/dose unless otherwise stated)
  • Please contact pharmacy for patients requiring vancomycin or aminoglycoside monitoring

AND

+/-

Dexamethasone 0.15 mg/kg IV q6h x 2-4 days

Before or at start of antimicrobial therapy

Step Down

May stepdown once patient improving clinically and supported by culture/sensitivities

Duration of Therapy

On Day 3, or when culture and susceptibility results are available, tailor antimicrobial therapy to pathogen

S. pneumoniae: 10-14 days

N. meningitidis: 5-7 days

H. influenzae: 7 days

Listeria monocytogenes: >21 days

Enterobacteriaceae: 21 days