Guidelines
Meningitis/Encephalitis

Meningitis/Encephalitis

Empiric Treatment

  • Addition of dexamethasone is recommended in all adult patients with suspected pneumococcal meningitis (most community-acquired adult patients).
  • Dose: 0.15 mg/kg IV q6h for 2-4 days
  • The first dose must be administered 10-20 minutes before or concomitant with the first dose of antibiotics. Administration of antibiotics should not be delayed to give dexamethasone. Dexamethasone should not be given to patients who have already started antibiotics.
  • Continue dexamethasone only if the CSF gram stain shows Gram-positive diplococci or if blood/CSF grows Streptococcus pneumonia, otherwise discontinue dexamethasone.
  • Consider adding rifampin 300 mg PO BID for suspected S. pneumoniae, pending susceptibilities, if dexamethasone is used. If S. pneumoniae is beta-lactam susceptible, rifampin may be discontinued.
  • History of CNS diseases (mass lesions, CVA)
  • New-onset seizure (≤ 1 week)
  • Papilledema
  • Altered consciousness
  • Focal neurologic deficit

Common Pathogens

HSV

If behavioral disturbance or focal neurologic signs (altered mental status, altered level of consciousness, cranial nerve deficits, hemiparesis, aphasia, ataxia, or focal seizures)

Listeria

If >50, immunocompromised, pregnant

Adapted from the UCLA Health Antimicrobial Stewardship Program