Initial Antibiotic Therapy for Suspected Bacterial Meningitis in Adults

Initial Antibiotic Therapy for Suspected Bacterial Meningitis in Adults

Setting	No penicillin allergy	Penicillin allergy
Adult aged under 60	Cefotaxime 2g qds or ceftriaxone 2g bd	Minor allergy: cefotaxime 2g qds or ceftriaxone 2g bd Severe allergy: chloramphenicol 25 mg/kg qds
Age over 60, Immunocompromised or chronic alcohol abuse In regions with a high prevalence of penicillin-resistant pneumococci	Cefotaxime 2gqds or ceftriaxone 2g bd+amoxicillin 2g 4 hourly Add vancomycin 15–20 mg/kg bd	Minor allergy: cefotaxime 2g qds or ceftriaxone 2gbd Severe allergy: chloramphenicol 25 mg/kgqds+co-trimoxazole 15 mg/kg (trimethoprim component) tds

Setting

No penicillin allergy

Penicillin allergy

Adult aged under 60

Cefotaxime 2g qds or ceftriaxone 2g bd

Minor allergy: cefotaxime 2g qds or ceftriaxone 2g bd

Severe allergy: chloramphenicol 25 mg/kg qds

Age over 60, Immunocompromised or chronic alcohol abuse

In regions with a high prevalence of penicillin-resistant pneumococci

Cefotaxime 2gqds or ceftriaxone 2g bd+amoxicillin 2g 4 hourly

Add vancomycin 15–20 mg/kg bd

Minor allergy: cefotaxime 2g qds or ceftriaxone 2gbd

Severe allergy: chloramphenicol 25 mg/kgqds+co-trimoxazole 15 mg/kg (trimethoprim component) tds