Bacterial meningitis

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Teoria 
Diagnóstico 
Tratamento 
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Observe que as formulações/vias e doses podem diferir entre nomes e marcas de medicamentos, formulários de medicamentos ou localidades. As recomendações de tratamento são específicas para os grupos de pacientes:ver aviso legal

Inicial

≤1 month of age and immunocompetent

1ª linha – empiric antibiotic therapy

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1ª linha –

empiric antibiotic therapy

Until the causative organism and its sensitivities have been identified, broad-spectrum antimicrobials should be given as soon as possible parenterally.[9][99][104]

The choice of empiric antibiotic depends on the patient's age and conditions that may have predisposed the patient to meningitis.[27] The regimen chosen must be broad enough to cover the potential organisms for the age group affected, with consideration for regional susceptibility rates.[59] The most common pathogens causing bacterial meningitis in neonates are Streptococcus agalactiae (group B streptococci), Escherichia coli, and Listeria monocytogenes.[27]

The recommended regimen is ampicillin plus cefotaxime.[59][104][27] If cefotaxime cannot be administered (e.g., patients with an allergy), an alternative regimen for neonates is ampicillin plus an aminoglycoside (e.g., gentamicin).[59]

After diagnosis is confirmed (generally within 12-48 hours of admission to the hospital), antimicrobial therapy can be modified according to causative organism and its susceptibilities.[9][27] Specialist advice should be sought for newborns.

Opções primárias

ampicillin: consult specialist for guidance on neonatal dose

cefotaxime: consult specialist for guidance on neonatal dose

Opções secundárias

ampicillin: consult specialist for guidance on neonatal dose

gentamicin: consult specialist for guidance on neonatal dose

associado a – supportive therapy

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supportive therapy

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Patients with symptoms of shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[121]

Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[9][121]

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation. Consult a specialist for guidance on suitable vasopressor/inotrope regimens.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

>1 month and <50 years of age and immunocompetent

1ª linha – empiric antibiotic therapy

Back

1ª linha –

empiric antibiotic therapy

Until the causative organism and its sensitivities have been identified, broad-spectrum antimicrobials should be given as soon as possible parenterally.[9][99][104]

The choice of empiric antibiotic depends on the patient's age and conditions that may have predisposed the patient to meningitis.[27] The regimen chosen must be broad enough to cover the potential organisms for the age group affected, with consideration for regional susceptibility rates.[59] Overall, the most common pathogens causing bacterial meningitis in adults and children are Neisseria meningitidis and Streptococcus pneumoniae.[26][27]

The recommended regimen is ceftriaxone or cefotaxime plus vancomycin.[59][104][27] If a cephalosporin cannot be administered (e.g., patients with an allergy), a carbapenem (e.g., meropenem) plus vancomycin can be considered.[1][107]

After diagnosis is confirmed (generally within 12-48 hours of admission to the hospital), antimicrobial therapy can be modified according to causative organism and its susceptibilities.[9][27]

Opções primárias

vancomycin: children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours

Mais

--E--

ceftriaxone: children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours

cefotaxime: children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours

Opções secundárias

vancomycin: children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours

Mais

meropenem: children ≥3 months of age and <50 kg body weight: 40 mg/kg intravenously every 8 hours, maximum 6 g/day; children ≥3 months of age and ≥50 kg body weight and adults: 2 g intravenously every 8 hours

associado a – supportive therapy

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supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Patients with shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[120][121]

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[120][121] Consult a specialist for guidance on suitable vasopressor/inotrope regimens.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Considerar – dexamethasone

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Considerar –

dexamethasone

Tratamento adicional recomendado para ALGUNS pacientes no grupo de pacientes selecionado

Ideally dexamethasone should be given to all patients older than 6 weeks who present with clinical features of bacterial meningitis.[6][64][104][108]

In the US, the Infectious Diseases Society of America recommends that dexamethasone be started immediately prior to, or in conjunction with, the first dose of antibiotics and continued for 2-4 days.[6][107] European and UK guidelines recommend starting dexamethasone shortly before or in conjunction with antibiotics, or within 4-12 hours if already commenced, respectively.[64][107]

Once the causative organism is isolated, the use of dexamethasone should be reviewed; guidelines recommend that it is only continued for bacterial meningitis caused by pneumococcus or Haemophilus influenzae type b (Hib) as these have the strongest evidence for benefit.[27][107][110]

Evidence suggests that there are benefits from high-dose dexamethasone in reducing mortality and hearing impairment in adults, and in reducing hearing loss and neurologic sequelae in children with bacterial meningitis; these benefits are seen particularly in Hib or pneumococcal meningitis.[110][112][113][114] In adults, there is also some evidence that these benefits may extend to nonpneumococcal and non- Haemophilus meningitis.[111]

The use of adjunctive dexamethasone in Listeria meningitis is controversial, and until more studies are performed it is not recommended.[27][116][117]

Opções primárias

dexamethasone sodium phosphate: children >6 weeks of age: 0.15 mg/kg intravenously every 6 hours; adults: 10 mg intravenously every 6 hours

≥50 years of age or immunocompromised

1ª linha – empiric antibiotic therapy

Back

1ª linha –

empiric antibiotic therapy

Until the causative organism and antibiotic sensitivities have been identified, broad-spectrum antimicrobials should be given as soon as possible parenterally.[9][99][104]

The choice of empiric antibiotic depends on the patient's age and conditions that may have predisposed the patient to meningitis.[27] The regimen chosen must be broad enough to cover the potential organisms for the age group affected, with consideration for regional susceptibility rates.[59] Overall, the most common pathogens causing bacterial meningitis in adults and children are Neisseria meningitidis and Streptococcus pneumoniae; cover should be added for Listeria monocytogenes when patients have relevant risk factors (e.g., age >50 years, immunocompromised, and newborns).[26][27]

The recommended regimen is ampicillin plus ceftriaxone or cefotaxime plus vancomycin.[59][104][27] If ampicillin cannot be administered (e.g., patients with an allergy), trimethoprim/sulfamethoxazole could be considered as an alternative for some patient groups to ensure cover for Listeria monocytogenes in place of ampicillin.[1][27]

After diagnosis is confirmed (generally within 12-48 hours of admission to the hospital), antimicrobial therapy can be modified according to the causative organism and its susceptibilities.[9][27]

Specialist advice should be sought for immunocompromised newborns.

Opções primárias

ampicillin: neonates: consult specialist for guidance on dose; children: 200-400 mg/kg/day intravenously given in divided doses every 4-6 hours, maximum 12 g/day; adults: 1-2 g intravenously every 3-4 hours

--E--

vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours

Mais

--E--

ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours

cefotaxime: neonates: consult specialist for guidance on dose; children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours

Opções secundárias

sulfamethoxazole/trimethoprim: children ≥2 months of age and adults: 10-20 mg/kg/day intravenously given in divided doses every 6-12 hours

Mais

--E--

vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults:15-20 mg/kg intravenously every 8-12 hours

Mais

--E--

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Show drug information for a patient with no comorbidities

Opções primárias

ampicillin

--E--

vancomycin

--E--

ceftriaxone

cefotaxime

Opções secundárias

sulfamethoxazole/trimethoprim

--E--

vancomycin

--E--

ceftriaxone

cefotaxime

associado a – supportive therapy

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associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

associado a – dexamethasone

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associado a –

dexamethasone

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Ideally dexamethasone should be given to all patients who present with clinical features of bacterial meningitis.[6][64][104][108]

Dexamethasone generally should not be withheld in immunocompromised patients. In studies where it has been given to patients with bacterial meningitis, including those with Listeria, mortality tended to be lower in those on adjunctive dexamethasone therapy as compared with those without dexamethasone therapy.[107][109] The use of adjunctive dexamethasone in Listeria meningitis is controversial, and until more studies are performed it is not recommended.[27][116][117]

Opções primárias

dexamethasone sodium phosphate: 10 mg intravenously every 6 hours

AGUDA

confirmed infection: Streptococcus pneumoniae

penicillin-susceptible

1ª linha – targeted antibiotic therapy

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1ª linha –

targeted antibiotic therapy

After diagnosis is confirmed (generally within 12-48 hours of admission to the hospital), antimicrobial therapy can be modified according to the causative organism and its susceptibilities.[9][27] Typically, the duration of antibacterial treatment depends on the patient's age, severity of infection, and response to initial therapy.

Penicillin-susceptible Streptococcus pneumoniae (i.e., minimum inhibitory concentration <0.06 microgram/mL) should be treated with penicillin-G or ampicillin. Alternatives include a third-generation cephalosporin (e.g., ceftriaxone).[27]

Treatment course: 10-14 days.

Opções primárias

penicillin G potassium: neonates: consult specialist for guidance on dose; children: 250,000 to 400,000 units/kg/day intravenously given in divided doses every 4-6 hours, maximum 24 million units/day; adults: 2 million units intravenously every 2 hours

Opções secundárias

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Considerar – dexamethasone

Back

Considerar –

dexamethasone

Tratamento adicional recomendado para ALGUNS pacientes no grupo de pacientes selecionado

Ideally dexamethasone should be given to all patients older than 6 weeks who present with clinical features of bacterial meningitis.[6][64][104][108]

Once the causative organism is isolated, the use of dexamethasone should be reviewed; guidelines recommend that dexamethasone be continued for bacterial meningitis caused by pneumococcus.[27][107][110]

Evidence suggests that there are benefits from high-dose dexamethasone in reducing mortality and hearing impairment in adults, and in reducing hearing loss and neurologic sequelae in children with bacterial meningitis; these benefits are seen particularly in Haemophilus influenzae type b (Hib) or pneumococcal meningitis.[110][112][113][114]

Corticosteroids are not currently recommended in neonates.[59]

Opções primárias

dexamethasone sodium phosphate: children >6 weeks of age: 0.15 mg/kg intravenously every 6 hours; adults: 10 mg intravenously every 6 hours

penicillin-intermediate sensitivity

1ª linha – targeted antibiotic therapy

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1ª linha –

targeted antibiotic therapy

Penicillin-intermediate Streptococcus pneumoniae (i.e., minimum inhibitory concentration [MIC] ≥0.12 microgram/mL) or ceftriaxone-intermediate (MIC <1 microgram/mL) should be treated with cefotaxime or ceftriaxone. Alternatives include a carbapenem (e.g., meropenem) or a fourth-generation cephalosporin (e.g., cefepime).[27]

Treatment course: 10-14 days.

Opções primárias

Opções secundárias

cefepime: children ≥2 months of age: 150 mg/kg/day intravenously given in divided doses every 8 hours; adults: 2 g intravenously every 8 hours

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Considerar – dexamethasone

Back

Considerar –

dexamethasone

Tratamento adicional recomendado para ALGUNS pacientes no grupo de pacientes selecionado

Ideally dexamethasone should be given to all patients older than 6 weeks who present with clinical features of bacterial meningitis.[6][64][104][108]

Evidence suggests that there are benefits from high-dose dexamethasone in reducing mortality and hearing impairment in adults, and in reducing hearing loss and neurologic sequelae in children with bacterial meningitis; these benefits are seen particularly in Haemophilus influenzae type b (Hib) and pneumococcal meningitis.[110][112][113][114]

Corticosteroids are not currently recommended in neonates.[59]

Opções primárias

dexamethasone sodium phosphate: children >6 weeks of age: 0.15 mg/kg intravenously every 6 hours; adults: 10 mg intravenously every 6 hours

penicillin-resistant

1ª linha – targeted antibiotic therapy

Back

1ª linha –

targeted antibiotic therapy

After diagnosis is confirmed (generally within 12-48 hours of admission to the hospital), antimicrobial therapy can be modified according to the causative organism and its susceptibilities.[9][99]

Penicillin-resistant Streptococcus pneumoniae (minimum inhibitory concentration [MIC] ≥2.0 micrograms/mL) or cephalosporin-resistant organisms (MIC ≥1.0 microgram/mL) should be treated with vancomycin plus ceftriaxone or cefotaxime. Alternatives include vancomycin plus a fluoroquinolone (e.g., levofloxacin, moxifloxacin).[27][107][138]

Systemic fluoroquinolone antibiotics may cause serious, disabling, and potentially long-lasting or irreversible adverse events. This includes, but is not limited to: tendinopathy/tendon rupture; peripheral neuropathy; arthropathy/arthralgia; aortic aneurysm and dissection; heart valve regurgitation; dysglycemia; and central nervous system effects including seizures, depression, psychosis, and suicidal thoughts and behavior.[145] Prescribing restrictions apply to the use of fluoroquinolones, and these restrictions may vary between countries. In general, fluoroquinolones should be restricted for use in serious, life-threatening bacterial infections only. Some regulatory agencies may also recommend that they must only be used in situations where other antibiotics, that are commonly recommended for the infection, are inappropriate (e.g., resistance, contraindications, treatment failure, unavailability). Consult your local guidelines and drug information source for more information on suitability, contraindications, and precautions.

Treatment course: 10-14 days.

Opções primárias

vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours

Mais

--E--

Opções secundárias

vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours

Mais

--E--

levofloxacin: children: consult specialist for guidance on dose; adults 750 mg intravenously every 24 hours

moxifloxacin: children: consult specialist for guidance on dose; adults 400 mg intravenously every 24 hours

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Considerar – dexamethasone

Back

Considerar –

dexamethasone

Tratamento adicional recomendado para ALGUNS pacientes no grupo de pacientes selecionado

Ideally dexamethasone should be given to all patients older than 6 weeks who present with clinical features of bacterial meningitis.[6][64][104][108]

Evidence suggests that there are benefits from high-dose dexamethasone in reducing mortality and hearing impairment in adults, and in reducing hearing loss and neurologic sequelae in children with bacterial meningitis; these benefits are seen particularly in Haemophilus influenzae type b (Hib) and pneumococcal meningitis.[110][112][113][114]

Corticosteroids are not currently recommended in neonates.[59]

Opções primárias

dexamethasone sodium phosphate: children >6 weeks of age: 0.15 mg/kg intravenously every 6 hours; adults: 10 mg intravenously every 6 hours

confirmed infection: Haemophilus influenzae

beta-lactamase-negative

1ª linha – targeted antibiotic therapy

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1ª linha –

targeted antibiotic therapy

Haemophilus influenzae beta-lactamase-negative patients should be treated with ampicillin. Alternatives include a third- or fourth-generation cephalosporin (e.g., ceftriaxone, cefepime) or a fluoroquinolone (e.g., levofloxacin, ciprofloxacin).[27]

Treatment course: 7-10 days.

Opções primárias

Opções secundárias

cefepime: children ≥2 months of age: 150 mg/kg/day intravenously given in divided doses every 8 hours; adults: 2 g intravenously every 8 hours

levofloxacin: children: consult specialist for guidance on dose; adults 750 mg intravenously every 24 hours

ciprofloxacin: children: consult specialist for guidance on dose; adults 400 mg intravenously every 8-12 hours

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Considerar – dexamethasone

Back

Considerar –

dexamethasone

Tratamento adicional recomendado para ALGUNS pacientes no grupo de pacientes selecionado

Ideally dexamethasone should be given to all patients older than 6 weeks who present with clinical features of bacterial meningitis.[6][64][104][108]

Evidence suggests that there is benefit from high-dose dexamethasone in reducing mortality and hearing impairment in adults with bacterial meningitis.[110]

In children, studies have shown corticosteroids likely reduce severe hearing loss in patients with Hib meningitis.[112][113]

One large meta-analysis found administration of low-dose corticosteroids to be beneficial in children in reducing hearing loss and neurologic sequelae, as well as reducing the mean number of days before resolution of fever.[114]

Corticosteroids are not currently recommended in neonates.[59]

Opções primárias

dexamethasone sodium phosphate: children >6 weeks of age: 0.15 mg/kg intravenously every 6 hours; adults: 10 mg intravenously every 6 hours

beta-lactamase-positive

1ª linha – targeted antibiotic therapy

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1ª linha –

targeted antibiotic therapy

Haemophilus influenzae beta-lactamase-positive patients should be treated with ceftriaxone or cefotaxime. Alternatives include a fourth-generation cephalosporin (e.g., cefepime) or a fluoroquinolone (e.g., levofloxacin, ciprofloxacin).[27]

Treatment course: 10-14 days.

Opções primárias

Opções secundárias

cefepime: children ≥2 months of age: 150 mg/kg/day intravenously given in divided doses every 8 hours; adults: 2 g intravenously every 8 hours

levofloxacin: children: consult specialist for guidance on dose; adults 750 mg intravenously every 24 hours

ciprofloxacin: children: consult specialist for guidance on dose; adults 400 mg intravenously every 8-12 hours

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

Considerar – dexamethasone

Back

Considerar –

dexamethasone

Tratamento adicional recomendado para ALGUNS pacientes no grupo de pacientes selecionado

Ideally dexamethasone should be given to all patients older than 6 weeks who present with clinical features of bacterial meningitis.[6][64][104][108]

Evidence suggests that there is benefit from high-dose dexamethasone in reducing mortality and hearing impairment in adults with bacterial meningitis.[110]

In children, studies have shown corticosteroids likely reduce severe hearing loss in patients with Hib meningitis.[112][113]

Corticosteroids are not currently recommended in neonates.[59]

Opções primárias

dexamethasone sodium phosphate: children >6 weeks of age: 0.15 mg/kg intravenously every 6 hours; adults: 10 mg intravenously every 6 hours

confirmed infection: Streptococcus agalactiae (group B streptococci)

1ª linha – targeted antibiotic therapy

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targeted antibiotic therapy

Streptococcus agalactiae (group B streptococci) should be treated with either ampicillin or penicillin-G. Alternatives include a third-generation cephalosporin (e.g., ceftriaxone, cefotaxime) or vancomycin.[27]

Treatment course: 14-21 days.

Opções primárias

Opções secundárias

vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours

Mais

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

confirmed infection: Escherichia coli and other gram-negative Enterobacteriaceae

1ª linha – targeted antibiotic therapy

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1ª linha –

targeted antibiotic therapy

Escherichia coli and other gram-negative Enterobacteriaceae should be treated with ceftriaxone or cefotaxime. Alternatives include aztreonam, a fluoroquinolone (e.g., ciprofloxacin), trimethoprim/sulfamethoxazole, meropenem, or ampicillin.[27][107]

Treatment course: 21-28 days.

Opções primárias

Opções secundárias

aztreonam: neonates: consult specialist for guidance on dose; children: 120-200 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 8 g/day, adults: 2 g intravenously every 6-8 hours

ciprofloxacin: children: consult specialist for guidance on dose; adults 400 mg intravenously every 8-12 hours

sulfamethoxazole/trimethoprim: children ≥2 months of age and adults: 10-20 mg/kg/day intravenously given in divided doses every 6-12 hours

Mais

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

confirmed infection: Listeria monocytogenes

1ª linha – targeted antibiotic therapy

Back

1ª linha –

targeted antibiotic therapy

After diagnosis is confirmed (generally within 12-48 hours of admission to the hospital), antimicrobial therapy can be modified according to the causative organism and antibiotic susceptibilities.[9][27] Typically, the duration of antibacterial treatment depends on the patient's age, severity of infection, and response to initial therapy.

Listeria monocytogenes should be treated with ampicillin or penicillin-G plus gentamicin.[27][107] Alternatives include trimethoprim/sulfamethoxazole.

Treatment course: 21-28 days.

Opções primárias

gentamicin: neonates: consult specialist for guidance on dose; children: 2 mg/kg intravenously every 8 hours; adults: 1 mg/kg intravenously every 8 hours

Mais

--E--

Opções secundárias

sulfamethoxazole/trimethoprim: children ≥2 months of age and adults: 10-20 mg/kg/day intravenously given in divided doses every 6-12 hours

Mais

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

confirmed infection: Staphylococcus aureus

methicillin-susceptible

1ª linha – targeted antibiotic therapy

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1ª linha –

targeted antibiotic therapy

Staphylococcus aureus that is methicillin-susceptible should be treated with nafcillin or oxacillin. Alternatives include vancomycin, linezolid, or daptomycin.[27][107]

Treatment course: depends on the patient's age, severity of infection, and response to initial therapy.

Opções primárias

nafcillin: neonates: consult specialist for guidance on dose; children: 200 mg/kg/day intravenously given in divided doses every 6 hours, maximum 12 g/day; adults: 2 g intravenously every 4 hours

oxacillin: neonates: consult specialist for guidance on dose; children: 200 mg/kg/day intravenously given in divided doses every 6 hours, maximum 12 g/day; adults: 2 g intravenously every 4 hours

Opções secundárias

vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours

Mais

linezolid: neonates: consult specialist for guidance on dose; children: 10 mg/kg intravenously every 8 hours, maximum 600 mg/dose; adults: 600 mg intravenously every 12 hours

daptomycin: children: consult specialist for guidance on dose; adults: 6-10 mg/kg intravenously every 24 hours

associado a – supportive therapy

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supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

methicillin-resistant

1ª linha – targeted antibiotic therapy

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targeted antibiotic therapy

Staphylococcus aureus that is methicillin-resistant should be treated with vancomycin. Alternatives include trimethoprim/sulfamethoxazole, linezolid, or daptomycin.[27][107]

Treatment course: depends on the patient's age, severity of infection, and response to initial therapy.

Opções primárias

vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours

Mais

Opções secundárias

sulfamethoxazole/trimethoprim: children ≥2 months of age and adults: 10-20 mg/kg/day intravenously given in divided doses every 6-12 hours

Mais

linezolid: neonates: consult specialist for guidance on dose; children: 10 mg/kg intravenously every 8 hours, maximum 600 mg/dose; adults: 600 mg intravenously every 12 hours

daptomycin: children: consult specialist for guidance on dose; adults: 6-10 mg/kg intravenously every 24 hours

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

confirmed infection: Staphylococcus epidermidis

1ª linha – targeted antibiotic therapy

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targeted antibiotic therapy

Staphylococcus epidermidis should be treated with vancomycin. Alternatives include linezolid.[107][139]

Treatment course: depends on the patient's age, severity of infection, and response to initial therapy.

Opções primárias

vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours

Mais

Opções secundárias

linezolid: neonates: consult specialist for guidance on dose; children: 10 mg/kg intravenously every 8 hours, maximum 600 mg/dose; adults: 600 mg intravenously every 12 hours

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

confirmed infection: Pseudomonas aeruginosa

1ª linha – targeted antibiotic therapy

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targeted antibiotic therapy

Pseudomonas aeruginosa should be treated with ceftazidime. Alternatives include meropenem.[107][140][141]

Treatment course: 21 days.

Opções primárias

ceftazidime sodium: neonates: consult specialist for guidance on dose; children: 150-200 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 6 g/day; adults: 2 g intravenously every 8 hours

Opções secundárias

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

confirmed infection: Enterococcus species

1ª linha – targeted antibiotic therapy

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1ª linha –

targeted antibiotic therapy

After diagnosis is confirmed (generally within 12-48 hours of admission to the hospital), antimicrobial therapy can be modified according to the causative organism and antibiotic susceptibilities.[9][99] Typically, the duration of antibacterial treatment depends on the patient's age, severity of infection, and response to initial therapy.

Enterococcus species should be treated with ampicillin plus gentamicin.[99][142][143] Alternatives include vancomycin plus gentamicin (if ampicillin resistant), or linezolid (if ampicillin and vancomycin resistant).[107]

Treatment course: 21 days.

Opções primárias

gentamicin: neonates: consult specialist for guidance on dose; children: 2 mg/kg intravenously every 8 hours; adults: 1 mg/kg intravenously every 8 hours

Mais

Opções secundárias

gentamicin: neonates: consult specialist for guidance on dose; children: 2 mg/kg intravenously every 8 hours; adults: 1 mg/kg intravenously every 8 hours

Mais

vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours

Mais

linezolid: neonates: consult specialist for guidance on dose; children: 10 mg/kg intravenously every 8 hours, maximum 600 mg/dose; adults: 600 mg intravenously every 12 hours

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

confirmed infection: Acinetobacter species

1ª linha – targeted antibiotic therapy

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targeted antibiotic therapy

Acinetobacter species should be treated with meropenem with or without gentamicin. An alternative regimen (in cases of resistance) includes polymyxin B (given intrathecally) plus an aminoglycoside with or without rifampin.[144]

Treatment course: 21 days.

Opções primárias

gentamicin: children: 2 mg/kg intravenously every 8 hours; adults: 1 mg/kg intravenously every 8 hours

Mais

Opções secundárias

polymyxin B: children <2 years of age: 25,000 units intrathecally once daily on alternate days; children ≥2 years of age: 50,000 units intrathecally once daily for 3-4 days, followed by 50,000 units once daily on alternate days; adults: 50,000 units intrathecally once daily

gentamicin: neonates: consult specialist for guidance on dose; children: 2 mg/kg intravenously every 8 hours; adults: 1 mg/kg intravenously every 8 hours

Mais

gentamicin: neonates: consult specialist for guidance on dose; children: 2 mg/kg intravenously every 8 hours; adults: 1 mg/kg intravenously every 8 hours

Mais

rifampin: children: consult specialist for guidance on dose; adults: 600 mg intravenously every 12 hours

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Show drug information for a patient with no comorbidities

Opções primárias

meropenem

gentamicin

Opções secundárias

polymyxin B

gentamicin

polymyxin B

gentamicin

rifampin

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

confirmed infection: Neisseria meningitidis

penicillin-susceptible

1ª linha – targeted antibiotic therapy

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targeted antibiotic therapy

Neisseria meningitidis that is penicillin-susceptible (minimum inhibitory concentration <0.1 microgram/mL) should be treated with ampicillin or penicillin-G. Alternatives include a third-generation cephalosporin (e.g., ceftriaxone).[27][107]

Treatment course: 7 days.

Opções primárias

Opções secundárias

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

penicillin-intermediate sensitivity

1ª linha – targeted antibiotic therapy

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targeted antibiotic therapy

Neisseria meningitidis that is penicillin-intermediate susceptible (minimum inhibitory concentration 0.1 to 1.0 microgram/mL) should be treated with ceftriaxone or cefotaxime. Alternatives include a fluoroquinolone (e.g., levofloxacin, ciprofloxacin) or meropenem.[27][107]

Treatment course: 7 days.

Opções primárias

Opções secundárias

levofloxacin: children: consult specialist for guidance on dose; adults 750 mg intravenously every 24 hours

ciprofloxacin: children: consult specialist for guidance on dose; adults 400 mg intravenously every 8-12 hours

associado a – supportive therapy

Back

associado a –

supportive therapy

Tratamento recomendado para TODOS os pacientes no grupo de pacientes selecionado

Tracheal intubation: animated demonstration

How to insert a tracheal tube in an adult using a laryngoscope.

Bag-valve-mask ventilation: animated demonstration

How to use bag-valve-mask apparatus to deliver ventilatory support to adults. Video demonstrates the two-person technique.

If the patient is hypovolemic or in shock, additional intravenous fluids must be given.

Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.

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Bacterial meningitis

Algoritmo de tratamento

≤1 month of age and immunocompetent

empiric antibiotic therapy

Opções primárias

Opções secundárias

These drug options and doses relate to a patient with no comorbidities.

Opções primárias

Opções secundárias

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Opções primárias

Opções secundárias

supportive therapy

>1 month and <50 years of age and immunocompetent

empiric antibiotic therapy

Opções primárias

Opções secundárias

These drug options and doses relate to a patient with no comorbidities.

Opções primárias

Opções secundárias

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Opções primárias

Opções secundárias

supportive therapy

dexamethasone

Opções primárias

These drug options and doses relate to a patient with no comorbidities.

Opções primárias

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Opções primárias

≥50 years of age or immunocompromised

empiric antibiotic therapy

Opções primárias

Opções secundárias

These drug options and doses relate to a patient with no comorbidities.

Opções primárias

Opções secundárias

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Opções primárias

Opções secundárias

supportive therapy

dexamethasone

Opções primárias

These drug options and doses relate to a patient with no comorbidities.

Opções primárias

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Opções primárias

confirmed infection: Streptococcus pneumoniae

penicillin-susceptible

targeted antibiotic therapy

Opções primárias

Opções secundárias

These drug options and doses relate to a patient with no comorbidities.

Opções primárias

Opções secundárias

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Opções primárias

Opções secundárias

supportive therapy

dexamethasone

Opções primárias

These drug options and doses relate to a patient with no comorbidities.

Opções primárias

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Opções primárias

penicillin-intermediate sensitivity

targeted antibiotic therapy

Opções primárias

Opções secundárias

These drug options and doses relate to a patient with no comorbidities.

Opções primárias

Opções secundárias

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Opções primárias

Opções secundárias

supportive therapy

dexamethasone

Opções primárias

These drug options and doses relate to a patient with no comorbidities.

Opções primárias