Notes

1. If meningitis is suspected, do not delay antibiotics while obtaining lumbar puncture or cultures.

2. Some regions have a high incidence of drug-resistant Streptococcus pneumoniae (DRSP) [susceptible MIC £0.1 pg/mL; intermediate >0.1 to £1.0; resistant 32.0]. If prevalence of DRSP is high (i.e., >2% isolates intermediate or resistant MIC), add vancomycin to regimen.

3. Some authorities recommend dexamethasone in children or adults with positive Gram stain or coma. Dexamethasone dose: 0.4 mg/kg IV q12h for 4 doses [C] with first dose given prior to antibiotics (if patient's condition permits, efficacy is improved if given 15-20 min before antibiotics).

A. NEONATAL AND INFANTS (UP TO 8 WEEKS OF AGE) (Note two or three drug therapy)

Note: Ceftriaxone is no longer recommended in neonates because of the potential for biliary sludge pseudolithiasis.

Cefotaxime (Claforan) 75 mg/kg IV or IM q6h [B]

PLUS (to cover group B Strep and Listeria)

Ampicillin 50 mg/kg IV or IM q6h [B]

PLUS/MINUS (to cover DRSP—see Notes, above)

Vancomycin (Vancocin) 15 mg/kg IV q6h (monitor serum levels) [C]

Organisms: group B Strep, E. coli, Listeria, Klebsiella, Enterobacter, S. aureus, H. influenzae

B. INFANT/CHILD

1. Cefotaxime (Claforan) 75 mg/kg IV or IM q6h [B] OR

2. Ceftriaxone (Rocephin) 50 mg/kg IV or IM q12h (max 2 g/dose) [B] PLUS/MINUS (to cover DRSP—see Notes, above)

1. Vancomycin (Vancocin) 15 mg/kg IV q6h (max 1 g/dose; monitor serum levels) [C]

Organisms: H. influenzae, S. pneumoniae, N. meningitidis

C. PEDIATRIC PATIENTS WITH A SEVERE PENICILLIN ALLERGY

Regimen A (Note two drug therapy)

Vancomycin (Vancocin) 15 mg/kg IV q6h (max 1 g/dose; monitor serum levels) [C] PLUS

TMP/SMX (Bactrim, Septra) 5 mg/kg IV q12h based on TMP [C; D in 3rd trimester] Regimen B (Note three drug therapy)

Vancomycin (Vancocin) 15 mg/kg IV q6h (max 1 g/dose; monitor serum levels) [C] PLUS

Gentamicin (Garamycin) 2 mg/kg IV loading dose, then 1.7 mg/kg IV q8h (monitor serum levels) [D] PLUS

Rifampin (Rimactane) 10-20 mg/kg IV qd (max 600 mg/dose) [C]

1. Ceftriaxone (Rocephin) 2 g IV q12h [B] OR

2. Cefotaxime (Claforan) 2 g IV q8h [B] PLUS/MINUS (to cover DRSP—see Notes, above)

Vancomycin (Vancocin) 15 mg/kg IV q6h (max 1 g/dose; monitor serum levels) [C] Organisms: S. pneumoniae, N. meningitidis

E. ADULT (>50 YEARS OF AGE, OR IMMUNOCOMPROMISED

(Note two or three drug therapy)

1. Ceftriaxone (Rocephin) 2 g IV q12h [B] OR

2. Cefotaxime (Claforan) 2 gm IV q8h [B] PLUS

Ampicillin 2 g IV q4h [B]

PLUS/MINUS (to cover DRSP—see Notes, above)

Vancomycin (Vancocin) 15 mg/kg IV q6h (max 1 g/dose; monitor serum levels) [C] Organisms: S. pneumoniae, N. meningitidis, Listeria, aerobic gram-negative bacilli

F. ADULT PATIENTS WITH A SEVERE PENICILLIN ALLERGY

Regimen A (Note two drug therapy)

Vancomycin (Vancocin) 15 mg/kg IV q6h (max 1 g/dose; monitor serum levels) [C] PLUS

TMP/SMX (Bactrim, Septra) 5 mg/kg IV q12h based on TMP [C; D in 3rd trimester] Regimen B (Note three drug therapy)

Vancomycin (Vancocin) 15 mg/kg IV q6h (max 1 g/dose; monitor serum levels) [C] PLUS

Gentamicin (Garamycin) 2 mg/kg IV loading dose, then 1.7 mg/kg IV q8h (monitor serum levels) [D]

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