Initial Antibiotics for Acute Bacterial Meningitis
Patient Group | Suspected Bacteria | Provisional Antibiotics |
|---|---|---|
Age | ||
< 3 months | Streptococcus agalactiae Escherichia coli or other gram-negative bacteria Listeria monocytogenes Staphylococcus aureus* | plus |
3 months–18 years | Neisseria meningitidis S. pneumoniae S. aureus* Haemophilus influenzae† | plus |
18–50 years | S. pneumoniae N. meningitidis S. aureus* | plus |
> 50 years | S. pneumoniae L. monocytogenes S. aureus Gram-negative bacteria N. meningitidis (unusual in this age group) | plus plus |
Route | ||
Sinusitis, otitis, CSF leaks | S. pneumoniae‡ H. influenzae Gram-negative bacteria including Pseudomonas aeruginosa Anaerobic or microaerophilic streptococci Bacteroides fragilis S. aureus* | plus plus |
Penetrating head wounds, neurosurgical procedures, shunt infections | S. aureus S. epidermidis Gram-negative bacteria including P. aeruginosa S. pneumoniae | plus |
Immune status | ||
AIDS, other conditions that impair cell-mediated immunity | S. pneumoniae L. monocytogenes Gram-negative bacteria including P. aeruginosa S. aureus* | plus plus |
* S. aureus | ||
† H. influenzae should be considered in children < 5 years with no record of H. influenzae type b conjugate vaccination. | ||
‡ S. pneumoniaeP. aeruginosa or Bacteroides | ||
CSF = cerebrospinal fluid. | ||