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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