Empirical Antimicrobial Therapy for Adult Patients with Presumed Bacterial Meningitis


* Ceftriaxone or cefotaxime.    Cefepime, ceftazidime.


Infection Empiric treatment
Meningitis–Community associated Dexamethasone 0.15 mg/kg IV every 6 h if pneumococcal meningitis suspected

Before or concomitantly with

Vancomycin dosed to goal trough 15–20 mcg/mL


Ceftriaxone 2 g IV every 12 h

If over age 50, pregnant or immune compromised

Add Ampicillin 2 g IV every 4 h

If herpes meningoencephalitis suspected

Add Acyclovir 10 mg/kg IV every 8 h


Textbook of Critical Care, Sixth Edition. Vincent, Jean-Louis, MD, PhD.

O’Horo, J. and Sampathkumar, P. (2017). Infections in Neurocritical Care. Neurocritical Care.

ENLS 2017 Pharmacotherapy.  Neurocritical Care Journal.


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