Guidelines
Age 2-50 years

Age 2-50 years

Dexamethasone

Recommended in all adult patients with suspected pneumococcal meningitis

Can be given 15-20 minutes prior to or with 1st antibiotic dose to prevent neurological complications

Dexamethasone

  • 0.15 mg/kg (maximum 10mg/dose) IV Q6H
  • Can be continued for 4 days

Empiric Therapy

  • Adult: 2g IV Q12H
  • Pediatric: 100 mg/kg/day IV divided every 12 to 24 hours; maximum daily dose: 4 g

PLUS

Pharmacy to dose to target trough 15-20 mcg/ml

CONSIDER ADDING

Acyclovir IV

  • If suspected encephalitis
  • Children 2 years to <12 years:

    • IV: 10 to 15 mg/kg/dose every 8 hours
  • Children ≥12 years and Adults:

    • IV: 10 mg/kg/dose every 8 hours
  • Dose adjustment required in renal impairment

Treatment Duration

Pathogen Dependent:

  • Neisseria meningitidis: 7 days
  • Haemophilus influenzae: 7 days
  • Streptococcus agalactiae: 14 - 21 days
  • Streptococcus pneumoniae: 10-14 days
  • Aerobic gram-negative bacilli: 21 days
  • Listeria monocytogenes: 21 days