Medical Pharmacology Chapter 35  Antibacterial Drugs

Meningitis

  • Most common cause of bacterial meningitis1:

    • Streptococcus pneumoniae

    • Neisseria meningitidis

  • Other causes:

    • Enteric gram-negative bacteria:

      • in the newborn

      • in patients more than 60 years old

      • neurosurgical patients

      • immunosuppressed patients

  • Treatments in adults and in children > 2 months old (in the absence of culture information):

    • Cefotaxime (Claforan) or and ceftriaxone (Rocephin) and plus vancomycin (Vancocin) (with or without rifampin (Rimactane) ) to cover resistant pneumococci

      •  vancomycin may not reach sufficient levels in cerebral spinal fluid (in certain patients

      • if the causative organism is susceptible to cephalosporins, vancomycin and rifampin treatment should be discontinued.

  • Treatment of Pseudomonas meningitis: ceftazidime (Fortax, Taxidime, Tazicef) plus aminoglycoside (tobramycin (Nebcin), gentamicin (Garamycin), or amikacin (Amikin))

  • Treatment of meningitis caused by Listeria: ampicillin (Principen, Omnipen) with or without gentamicin (Garamycin)

Special Cases

  • In penicillin-allergic patients:

    • In the absence of allergic reactions to cephalosporins, cefotaxime (Claforan) or ceftriaxone (Rocephin) may be used

      • vancomycin (Vancocin) with or without rifampin (Rimactane): added to cover resistant pneumococci

    • If cephalosporins may not be used: chloramphenicol (Chloromycetin) may serve for initial treatment:

      •  may not be effective for infection due to enteric gram-negative bacilli or in some patients with pneumococcal meningitis.

    • Enteric gram-negative bacilli: aztreonam (Azactan)

    • Listeria meningitis (penicillin-allergic patients): trimethoprim-sulfamethoxazole (Bactrim)

  • In Children:

    • Administration of dexamethasone before or concurrent with the first antibiotic dose has been recommended by some to reduce the incidence of hearing loss and other neurological complications and children with meningitis. 2 Most pediatric infectious disease specialists recommended using dexamethasone at least in meningitis due to Haemophilus influenzae.

  • In Newborns:

    • Meningitis most often caused by:

      • group B or other streptococci

      • gram-negative enteric bacteria

      • Listeria

    • Prior to definitive results from culture, treatment:

      • ampicillin (Principen, Omnipen) plus cefotaxime (Claforan) (with or without gentamicin (Garamycin))

 
The Choice of Antibacterial Drugs (Abramowicz, M, ed) The Medical Letter of Drugs and Therapeutics, vol. 40 (Issue 1023), March 27, 1998.

1Qualiarello, VJ and Scheld, WM, N Engl J Med, 336:708, 1997

2McIntyre, PB et al, JAMA, 278:925, 1997.

This Web-based pharmacology and disease-based integrated teaching site is based on reference materials, that are believed reliable and consistent with standards accepted at the time of development. Possibility of human error and on-going research and development in medical sciences do not allow assurance that the information contained herein is in every respect accurate or complete. Users should confirm the information contained herein with other sources. This site should only be considered as a teaching aid for undergraduate and graduate biomedical education and is intended only as a teaching site. Information contained here should not be used for patient management and should not be used as a substitute for consultation with practicing medical professionals. Users of this website should check the product information sheet included in the package of any drug they plan to administer to be certain that the information contained in this site is accurate and that changes have not been made in the recommended dose or in the contraindications for administration.  Advertisements that appear on this site are not reviewed for content accuracy and it is the responsibility of users of this website to make individual assessments concerning this information.  Medical or other information  thus obtained should not be used as a substitute for consultation with practicing medical or scientific or other professionals.