UNIVERSITY OF PENNSYLVANIA MEDICAL CENTER GUIDELINES FOR ANTIBIOTIC USE

CENTRAL NERVOUS SYSTEM INFECTIONS

Recommendations are for empiric therapy.
Directed therapy should be based upon culture and sensitivity results.
Clinical Setting Likely Pathogens Empiric Treatment Options Duration/Comments
Meningitis
Community-acquired meningitis, age 18-50

S. pneumoniae

N. meningitidis

H. influenzae

ceftriaxone 2g IV q12h + vancomycin (see comments)

Duration 10-14 days

Vancomycin dosing for pneumococcal meningitis has not been studied in detail. Some authorities recommend 30-45mg/kg/d for meningitis, given 8-12 hourly (10-15mg/kg q8h) with maximum doses of 2-3g/d (700-1000mg q8h) with normal renal function.
Community-acquired meningitis, age > 50

S. pneumoniae

N. meningitidis

H. influenzae

L. monocytogenes (risk factors include: age > 50 years, immunocompromised, pregnancy)

ceftriaxone 2g IV q12h + vancomycin (see comments) + ampicillin 2g IV q4h

Duration 10-14 days

Vancomycin dosing for pneumococcal meningitis has not been studied in detail. Some authorities recommend 30-45mg/kg/d for meningitis, given 8-12 hourly (10-15mg/kg q8h) with maximum doses of 2-3g/d (700-1000mg q8h) with normal renal function.
Post-surgical meningitis

S. aureus

coagulase-negative staphylococci

gram-negative bacilli

cefepime 2g IV q8h + vancomycin (see nomogram)

Duration 14 days

If S. aureus or coagulase-negative staphylococcus, use intraventricular vancomycin 10-20mg once daily every 1-3 days until clinical and microbiologic improvement occurs.

If gram-negative bacilli, use intraventricular gentamicin 5-10mg once daily every 1-3 days until clinical and microbiologic improvement occurs. The gentamicin must be preservative free. (Amikacin can be used in place of gentamicin at the same dosage.)

 

Brain Abscess
Community-acquired brain abscess upper respiratory flora ceftriaxone 2g IV q12h + metronidazole 500mg q12h Duration ~ 4-6 weeks or until resolved
Post-surgical brain abscess

S. aureus

coagulase-negative staphylococci

gram-negative bacilli

cefepime 2g IV q8h + vancomycin (see nomogram) Duration ~ 4-6 weeks or until resolved

Updated on 12/02/08 by Leanne Gasink, MD, MSCE

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