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§ |
* 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.
REF. UpToDate 2019.12.26