Meningitis

Question 1

Empiric therapy for meningitis in neonates <1 month

Answer 1

Target S. agalactiae, E. coli, Listeria

IV Ceftriaxone + IV Ampicillin

Question 2

Empiric therapy for meningitis in infants (1 - 23 month)

Answer 2

Target S. pneumoniae, Neisseria, E. coli, S. agalactiae

IV Ceftriaxone + IV Vancomycin

Question 3

Empiric therapy for meningitis in children & adults (2-50 y.o.)

Answer 3

Target S. pneumoniae, Neisseria

IV Ceftriaxone + IV Vancomycin

Question 4

Empiric therapy for meningitis in older adults >50 y.o.

Answer 4

Target S. pneumoniae, Neisseria, GNBs, Listeria

IV Ceftriaxone + IV Vancomycin + IV Ampicillin

Question 5

Targeted therapy for meningitis due to S. pneumoniae

Answer 5

IV Pen GK 4 MU q4 hours or
IV Ampicillin or
IV Ceftriaxone or
IV Vancomycin + IV Rifampicin 300 mg q12 hours

x 10-14 days

Question 6

Targeted therapy for meningitis due to S. agalactiae

Answer 6

IV Pen GK 4 MU q4 hours or
IV Ampicillin or
IV Ceftriaxone

x 14-21 days

Question 7

Targeted therapy for meningitis due to Neisseria

Answer 7

IV Pen GK 4 MU q4 hours or
IV Ampicillin or
IV Ceftriaxone

x 5-7 days

Question 8

Targeted therapy for meningitis due to Listeria

Answer 8

IV Pen GK 4 MU q4 hours or
IV Ampicillin or
PO Co-trimoxazole or
IV Meropenem

x at least 21 days

Question 9

Chemoprophylaxis for meningococcal meningitis in adults

Answer 9

PO Rifampicin 600 mg q12 hours x 4 doses or
PO Ciprofloxacin 500 mg single dose or
IM Ceftriaxone 125-250 mg single dose

Question 10

Chemoprophylaxis for meningococcal meningitis in children

Answer 10

PO Rifampicin 10 mg/kg or 5 mg/kg q12 hours x 4 doses or
PO Ceftriaxone 125-250 mg single dose

Question 11

Place in therapy for IV dexamethasone

Answer 11

To be given before or with 1st dose Abx

Main benefit with:
- H. influenzae in infants & children (reduce hearing loss)
- S. pneumo in adults (reduce mortality)