Antibiotics Used in Empirical Therapy of Bacterial Meningitis and Focal Central Nervous System Infectionsa
| Indication | Antibiotic | |
|---|---|---|
| Preterm infants to infants <1 month | Ampicillin + cefotaxime | |
| Infants 1-3 months | Ampicillin + cefotaxime or ceftriaxone | |
| Immunocompetent children >3 months and adults <55 | Cefotaxime, ceftriaxone, or cefepime + vancomycin | |
| Adults >55 and adults of any age with alcoholism or other debilitating illnesses | Ampicillin + cefotaxime, ceftriaxone or cefepime + vancomycin | |
| Hospital-acquired meningitis, posttraumatic or postneurosurgery meningitis, neutropenic patients, or patients with impaired cell-mediated immunity | Ampicillin + ceftazidime or meropenem + vancomycin | |
| Total Daily Dose and Dosing Interval | ||
| Antimicrobial Agent | Child (>1 month) | Adult |
| Ampicillin | 300 (mg/kg)/d, q6h | 12 g/d, q4h |
| Cefepime | 150 (mg/kg)/d, q8h | 6 g/d, q8h |
| Cefotaxime | 225-300 (mg/kg)/d, q6h | 12 g/d, q4h |
| Ceftriaxone | 100 (mg/kg)/d, q12h | 4 g/d, q12h |
| Ceftazidime | 150 (mg/kg)/d, q8h | 6 g/d, q8h |
| Gentamicin | 7.5 (mg/kg)/d, q8hb | 7.5 (mg/kg)/d, q8h |
| Meropenem | 120 (mg/kg)/d, q8h | 6 g/d, q8h |
| Metronidazole | 30 (mg/kg)/d, q6h | 1500-2000 mg/d, q6h |
| Nafcillin | 100-200 (mg/kg)/d, q6h | 9-12 g/d, q4h |
| Penicillin G | 400,000 (U/kg)/d, q4h | 20-24 million U/d, q4h |
| Vancomycin | 45-60 (mg/kg)/d, q6h | 45-60 (mg/kg)/d, q6-12hb |
aAll antibiotics are administered intravenously; doses indicated assume normal renal and hepatic function.
bDoses should be adjusted based on serum peak and trough levels: gentamicin therapeutic level: peak: 5-8 µg/mL; trough: <2 µg/mL; vancomycin therapeutic level: peak: 25-40 µg/mL; trough: 5-15 µg/mL.