• 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.

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• 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))

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

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