University of Pennsylvania Medical Center Guidelines for Antibiotic Use
| Clinical Setting | Empiric Treatment | Likely Pathogens | Definitive Treatment | Dosage Regimen | Duration |
| Meningitis | |||||
| Community- acquired |
18-50 yr. old ceftriaxone ± vancomycin1 |
S. pneumoniae | If MIC <=0.1: penicillin G | 12-20mu/d IV in 6 divided doses | 10-14 days |
| If MIC >0.1:1 ceftriaxone | 2gm IV q 12 hour | ||||
| N. meningitidis | ceftriaxone | 2gm IV q 12 hour | |||
| H. influenzae | ceftriaxone | 2gm IV q 12 hour | |||
| Community- acquired |
>50 yr. old ampicillin + ceftriaxone ± vancomycin1 |
as above | as above | as above | 10-14 days |
| L. monocytogenes2 |
ampicillin ± gentamicin |
2gm IV q 4 hour consult pharmacokinetics service |
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| gram negative bacilli |
ceftriaxone (cefepime: if P. aeruginosa) |
2gm IV q 12 hour 2gm IV q 8 hour |
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| Post- surgical | meropenem7 + vancomycin | S. aureus | nafcillin3 ± intraventricular vancomycin5 | 2gm IV q 4 hour | 14 days |
| coagulase negative staphylococcus | vancomycin ± intraventricular vancomycin5 | consult dosing information at this link | |||
| acinetobacter | imipenem | consult dosing information at this link | |||
| other gram negative bacilli |
ceftriaxone4 ± intraventricular gentamicin6 (cefepime ± intraventricular gentamicin if P. aeruginosa) |
2gm IV q 12 hour 2gm IV q 8 hour |
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| Brain Abscess | ceftriaxone + metronidazole | upper respiratory flora | ceftriaxone + | 2gm IV q 12 hour | Until resolved |
| metronidazole | 500mg IV/PO q 12 hour | ||||
| (nafcillin3 if S. aureus) | 2gm IV q 4 hour | ||||
1Several cases of ceftriaxone resistant pneumoccoci have been reported. Vancomycin dosing for pneumococcal meningitis has not been studied in detail but some authorities recommend the use of 30-45mg/kg/d for meningitis, given 8-12 hourly (10-15 mg/kg/8h) with maximum doses of 2 to 3g/d (700 to 1000 mg q 8h) with normal renal function. Vancomycin should be stopped if the pneumococcus is not penicillin resistant. Consult pharmacokinetics.
2Risk factors for L. monocytogenes: age > 50 years, HIV and other immunosuppressive states, pregnancy
3If beta-lactam allergy use trimethoprim/sulfamethoxazole; if MRSA-use vancomycin
4If organism is ceftriaxone susceptible
5 The dosage for intraventricular vancomycin is 10-20 mg once daily every 1 to 3 days until clinical and microbiologic improvement occurs.
6The dosage for intraventricular gentamicin is 5-10 mg once daily every 1 to 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, in case of gentamicin resistance.
7The dosage for meropenem is 2g IV q 8H, with modifications made for abnormal renal function
modified 11/21/04 by Paul Edelstein