수막염에서 권고되는 경험적 항생제, Recommendations for empiric antimicrobial therapy for purulent meningitis

Recommendations for empiric antimicrobial therapy for purulent meningitis based on patient age and specific predisposing condition*

Predisposing factor	Common bacterial pathogens	Antimicrobial therapy
Age
<1 month	Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes	Ampicillin plus cefotaxime; OR ampicillin plus an aminoglycoside
1 to 23 months	Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenzae, E. coli	Vancomycin plus a third-generation cephalosporin¶Δ◊
2 to 50 years	N. meningitidis, S. pneumoniae	Vancomycin plus a third-generation cephalosporin¶Δ◊
>50 years	S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gram-negative bacilli	Vancomycin plus ampicillin plus a third-generation cephalosporin¶Δ
Head trauma
Basilar skull fracture	S. pneumoniae, H. influenzae, group A beta-hemolytic streptococci	Vancomycin plus a third-generation cephalosporin¶Δ
Penetrating trauma	Staphylococcus aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic gram-negative bacilli (including Pseudomonas aeruginosa)	Vancomycin plus cefepime; OR vancomycin plus ceftazidime; OR vancomycin plus meropenem
Postneurosurgery	Aerobic gram-negative bacilli (including P. aeruginosa), S. aureus, coagulase-negative staphylococci (especially S. epidermidis)	Vancomycin plus cefepime; OR vancomycin plus ceftazidime; OR vancomycin plus meropenem
Immunocompromised state	S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gram-negative bacilli (including P. aeruginosa)	Vancomycin plus ampicillin plus cefepime; OR vancomycin plus meropenem§

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* For recommended dosages for adults, refer to the UpToDate table on recommended intravenous dosages of antimicrobial therapy for adults with bacterial meningitis.

¶ Ceftriaxone or cefotaxime.

Δ Some experts would add rifampin if dexamethasone is also given.

◊ Add ampicillin if meningitis caused by Listeria monocytogenes is suspected.

§ Meropenem provides sufficient coverage for Listeria when used as part of an initial regimen. However, if Listeria is identified, the patient should generally be switched to a regimen that includes ampicillin. Refer to the UpToDate topic that discusses treatment of Listeria for a discussion of regimen selection.

Modified with permission from: Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 2004; 39:1267. Copyright © 2004 University of Chicago Press.

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REF. UpToDate 2019.12.26