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Guidelines
Bacterial Meningitis

Bacterial Meningitis

Pearls

Bacterial Meningitis is considered a neurologic emergency, do not delay antimicrobials

History of CNS disease:

  • Mass lesion, stroke, or focal infection
  • Immunocompromised state
  • New onset seizure
  • Papilledema
  • Abnormal LOC
  • Focal deficit
  • Should be discontinued if Streptococcus pneumoniae is not supported by blood or CSF cultures
  • Do not start dexamethasone if antibiotics are already on board

Empiric Treatment

Dexamethasone 0.15 mg/kg IV q6h x 3 days

1st dose before or with abx

PLUS

OR

Cefepime 2g IV q8h
​

Choose Cefepime if immunocompromised, infected shunt, post neurosurgical, or penetrating head trauma; otherwise, choose ceftriaxone first line

OR

Meropenem 2g IV q8h
​

Restricted to Use-Criteria

PLUS

Listeria Coverage if >50 Years Old or Immunocompromised

OR

OR

ADD Meropenem 2g IV q8h
​

Restricted to Use-Criteria

Duration

  • Streptococcus pneumoniae = 10-14 days
  • Streptococcus agalactiae = 14-21 days
  • Neisseria meningitidis = 7 days
  • Listeria ≥ 21 days
  • Haemophilus influenza = 7 days
  • Aerobic gram-negative bacilli = 21 days