Bacterial meningitis

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1st line –

empiric antibiotic therapy

Until the causative organism and its sensitivities have been identified, broad-spectrum antimicrobials should be given parenterally.[9][65][68]

The choice of empiric antibiotic depends on the patient's age and conditions that may have predisposed the patient to meningitis.[65]

The regimen chosen must be broad enough to cover the potential organisms for the age group affected.

For initial therapy, likely antimicrobial resistance should be assumed.[65]

If a cephalosporin cannot be administered (e.g., with an allergy), an alternative antibiotic for neonates is an aminoglycoside (e.g., gentamicin).[38]

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][65]

Primary options

ampicillin: consult specialist for guidance on dose

and

cefotaxime: consult specialist for guidance on dose

Secondary options

ampicillin: consult specialist for guidance on dose

and

gentamicin: consult specialist for guidance on dose

>1 month and <50 years of age

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Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

Patients with symptoms of compensated shock (neurologic status usually remains normal, but the 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 supplemental oxygen. Those with decompensated shock (signs of compensated shock plus hypotension), hypoxia, severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure require intubation and mechanical ventilation.

Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy to control and prevent seizures (e.g., lorazepam, diazepam, phenytoin), and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[9]

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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.

Back

1st line –

empiric antibiotic therapy

Until the causative organism and its sensitivities have been identified, broad-spectrum antimicrobials should be given parenterally.[9][65][68]

The regimen chosen must be broad enough to cover the potential organisms for the age group affected.

For initial therapy, likely antimicrobial resistance should be assumed.[65]

If a cephalosporin cannot be administered (e.g., with an allergy), alternative antibiotics are a carbapenem (e.g., meropenem) or chloramphenicol.

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][65]

Primary options

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

-- AND --

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

cefotaxime: children: 200 mg/kg/day intravenously given in divided doses every 6 hours; adults: 2 g intravenously every 4 hours

Secondary options

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

-- AND --

meropenem: children: 120 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1-2 g intravenously every 8 hours

chloramphenicol: children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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.

Back

Plus –

dexamethasone

Treatment recommended for ALL patients in selected patient group

Ideally, adjuvant dexamethasone should be given with or shortly before the first dose of parenteral antibiotics in all previously well and non-immunosuppressed adults and children.[68] However, it may be given within 4 hours of the first dose of antibiotics.[38]

Evidence of potential benefit has been demonstrated in cases of bacterial meningitis associated with Haemophilus influenzae or Streptococcus pneumoniae. There is little evidence to support the use of dexamethasone in cases caused by other bacteria (e.g., in cases of meningococcal meningitis); dexamethasone should be stopped early when H influenzae and S pneumoniae have been excluded as causative organisms.[38]

Adjunctive therapy with dexamethasone, given before or within 4 hours of the first dose of antibiotics and continued for 4 days, has been shown to improve outcomes in adults.[38][71][72][73][74]

One Cochrane review found insufficient evidence to demonstrate that adding corticosteroids to antibacterial therapy reduced overall mortality in a mixed population of adults and children with acute bacterial meningitis.[73] Significant reduction in rates of hearing loss and neurologic sequelae were, however, reported in adults and children; short-term neurologic sequelae were reduced in children, but not in adults.[73] [ ] [ ] These results were replicated in a subsequent meta-analysis of randomized controlled trials related to the treatment of bacterial meningitis in children with dexamethasone.[75]

Subgroup analyses of the Cochrane review suggested that corticosteroids may reduce: mortality in S pneumoniae meningitis (but not in H influenzae type b [Hib] or Neisseria meningitidis meningitis); severe hearing loss in children with Hib meningitis (but not in children with meningitis due to non-Haemophilus species).[73]

One meta-analysis that included a heterogeneous group of critically ill adult patients reported potentially improved survival among a subgroup of patients with bacterial meningitis who received corticosteroids compared with those who did not (mortality 28% vs. 32%; P=0.04).[76]

Primary options

dexamethasone sodium phosphate: children ≥1 month of age: 0.6 mg/kg/day intravenously given in divided doses every 6 hours; adults: 10 mg intravenously every 6 hours

≥50 years of age

Back

1st line –

empiric antibiotic therapy

Until the causative organism and antibiotic sensitivities have been identified, broad-spectrum antimicrobials should be given parenterally.[9][65][68]

Choice of empiric antibiotic depends on patient's age and conditions that may have predisposed the patient to meningitis.[65]

The regimen chosen must be broad enough to cover the potential organisms for the age group affected.

For initial therapy, likely antimicrobial resistance should be assumed.[65]

If a cephalosporin cannot be administered (e.g., with an allergy), alternative antibiotics are a carbapenem (e.g., meropenem) or chloramphenicol. Trimethoprim/sulfamethoxazole is an alternative drug for ampicillin.

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][65]

Primary options

ampicillin: 2 g intravenously every 4 hours

and

vancomycin: 15-20 mg/kg intravenously every 8-12 hours

-- AND --

ceftriaxone: 2 g intravenously every 12 hours

cefotaxime: 2 g intravenously every 4 hours

Secondary options

sulfamethoxazole/trimethoprim: 8-10 mg/kg/day intravenously given in divided doses every 6-12 hours

and

vancomycin: 15-20 mg/kg intravenously every 8-12 hours

-- AND --

meropenem: 1-2 g intravenously every 8 hours

chloramphenicol: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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.

Back

Plus –

dexamethasone

Treatment recommended for ALL patients in selected patient group

Adjunctive therapy with dexamethasone, given before or within 4 hours of the first dose of antibiotics and continued for 4 days, has been shown to improve outcomes in adults.[38][71][72][73][74]

Primary options

dexamethasone sodium phosphate: 10 mg intravenously every 6 hours

immunocompromised

any age

Back

1st line –

empiric antibiotic therapy

Until the causative organism and antibiotic sensitivities have been identified, broad-spectrum antimicrobials should be given parenterally.[9][65][68]

Choice of empiric antibiotic depends on patient's age and conditions that may have predisposed the patient to meningitis.[65]

The regimen chosen must be broad enough to cover the potential organisms for the age group affected.

For initial therapy, likely antimicrobial resistance should be assumed.[65]

If a cephalosporin cannot be administered (e.g., with an allergy), alternative antibiotics include a carbapenem (e.g., meropenem) or chloramphenicol. Trimethoprim/sulfamethoxazole is an alternative drug for ampicillin (excluding newborns).

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][65]

Primary options

ampicillin: neonates: consult specialist for guidance on dose; children: 100-200 mg/kg/day intravenously given in divided doses every 6 hours; adults: 2 g intravenously every 4 hours

and

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

-- AND --

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

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

Secondary options

sulfamethoxazole/trimethoprim: children >2 months of age: 15-20 mg/kg/day intravenously given in divided doses every 6-8 hours; adults: 8-10 mg/kg/day intravenously given in divided doses every 6-12 hours

and

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

-- AND --

meropenem: neonates: consult specialist for guidance on dose; children: 120 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1-2 g intravenously every 8 hours

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

penicillin-susceptible

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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.

ACUTE

confirmed infection: Streptococcus pneumoniae

Back

1st line –

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][65]

Penicillin-susceptible organisms (i.e., minimum inhibitory concentration <0.1 microgram/mL) should be treated with penicillin-G or ampicillin.

Patients with a penicillin allergy may use chloramphenicol. Treatment course: 10 to 14 days.

Primary options

penicillin G potassium: neonates: consult specialist for guidance on dose; children: 250,000 to 300,000 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

ampicillin: neonates: consult specialist for guidance on dose; children: 100-200 mg/kg/day intravenously given in divided doses every 6 hours; adults: 2 g intravenously every 4 hours

Secondary options

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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

Back

Plus –

dexamethasone

Treatment recommended for ALL patients in selected patient group

Adjunctive therapy with dexamethasone, given before or within 4 hours of the first dose of antibiotics and continued for 4 days, has been shown to improve outcomes in adults.[38][71][72][73][74]

Corticosteroids are not currently recommended in neonates.[38]

Primary options

dexamethasone sodium phosphate: children ≥1 month of age: 0.6 mg/kg/day intravenously given in divided doses every 6 hours; adults: 10 mg intravenously every 6 hours

Back

1st line –

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][65]

Penicillin-intermediate organisms (i.e., minimum inhibitory concentration 0.1 to 1.0 microgram/mL) should be treated with cefotaxime or ceftriaxone.

If a cephalosporin cannot be administered (e.g., with an allergy), alternative antibiotics are a carbapenem (e.g., meropenem) or chloramphenicol.

Treatment course: 10 to 14 days.

Primary options

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

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

Secondary options

meropenem: neonates: consult specialist for guidance on dose; children: 120 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1-2 g intravenously every 8 hours

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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.

Back

Plus –

dexamethasone

Treatment recommended for ALL patients in selected patient group

Adjunctive therapy with dexamethasone, given before or within 4 hours of the first dose of antibiotics and continued for 4 days, has been shown to improve outcomes in adults.[38][71][72][73][74]

Corticosteroids are not currently recommended in neonates.[38]

Primary options

dexamethasone sodium phosphate: children ≥1 month of age: 0.6 mg/kg/day intravenously given in divided doses every 6 hours; adults: 10 mg intravenously every 6 hours

penicillin-resistant

Back

1st line –

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][65]

Penicillin-resistant (minimum inhibitory concentration [MIC] ≥2.0 micrograms/mL) or cephalosporin-resistant organisms (MIC ≥1.0 microgram/mL) should be treated with vancomycin in addition to cefotaxime or ceftriaxone.

If a cephalosporin cannot be administered (e.g., with an allergy), alternative antibiotics are a carbapenem (e.g., meropenem) or chloramphenicol.

Treatment course: 10 to 14 days.

Primary options

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

-- AND --

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

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

Secondary options

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

-- AND --

meropenem: neonates: consult specialist for guidance on dose; children: 120 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1-2 g intravenously every 8 hours

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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.

beta-lactamase-negative

Back

Plus –

dexamethasone

Treatment recommended for ALL patients in selected patient group

Adjunctive therapy with dexamethasone, given before or within 4 hours of the first dose of antibiotics and continued for 4 days, has been shown to improve outcomes in adults.[38][71][72][73][74]

Corticosteroids are not currently recommended in neonates.[38]

Primary options

dexamethasone sodium phosphate: children ≥1 month of age: 0.6 mg/kg/day intravenously given in divided doses every 6 hours; adults: 10 mg intravenously every 6 hours

confirmed infection: Haemophilus influenzae

Back

1st line –

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][65]

Treatment course: 7 to 10 days.

Primary options

ampicillin: neonates: consult specialist for guidance on dose; children: 100-200 mg/kg/day intravenously given in divided doses every 6 hours; adults: 2 g intravenously every 4 hours

Secondary options

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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.

beta-lactamase-positive

Back

Plus –

dexamethasone

Treatment recommended for ALL patients in selected patient group

Adjunctive therapy with dexamethasone, given before or within 4 hours of the first dose of antibiotics and continued for 4 days, has been shown to improve outcomes in adults.[38][71][72][73][74]

Corticosteroids are not currently recommended in neonates.[38]

Primary options

dexamethasone sodium phosphate: children ≥1 month of age: 0.6 mg/kg/day intravenously given in divided doses every 6 hours; adults: 10 mg intravenously every 6 hours

Back

1st line –

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][65]

If a cephalosporin cannot be administered (e.g., with an allergy), alternative antibiotics are a carbapenem (e.g., meropenem) or chloramphenicol.

Treatment course: 10 to 14 days.

Primary options

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

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

Secondary options

meropenem: neonates: consult specialist for guidance on dose; children: 120 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1-2 g intravenously every 8 hours

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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.

Back

Plus –

dexamethasone

Treatment recommended for ALL patients in selected patient group

Adjunctive therapy with dexamethasone, given before or within 4 hours of the first dose of antibiotics and continued for 4 days, has been shown to improve outcomes in adults.[38][71][72][73][74]

Corticosteroids are not currently recommended in neonates.[38]

Primary options

dexamethasone sodium phosphate: children ≥1 month of age: 0.6 mg/kg/day intravenously given in divided doses every 6 hours; adults: 10 mg intravenously every 6 hours

confirmed infection: Streptococcus agalactiae (group B streptococci)

Back

1st line –

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][65]

An alternative antibiotic for patients with a penicillin allergy is chloramphenicol.

Treatment course: 14 to 21 days.

Primary options

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

-- AND --

ampicillin: neonates: consult specialist for guidance on dose; children: 100-200 mg/kg/day intravenously given in divided doses every 6 hours; adults: 2 g intravenously every 4 hours

Secondary options

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

and

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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

Back

1st line –

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][65]

If a cephalosporin cannot be administered (e.g., with an allergy), alternative antibiotics are a carbapenem (e.g., meropenem) or chloramphenicol.

Treatment course: 21 to 28 days.

Primary options

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

-- AND --

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

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

Secondary options

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

-- AND --

meropenem: neonates: consult specialist for guidance on dose; children: 120 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1-2 g intravenously every 8 hours

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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

Back

1st line –

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][65]

An alternative antibiotic for patients with a penicillin allergy is chloramphenicol.

Treatment course: 21 to 28 days.

Primary options

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

-- AND --

ampicillin: neonates: consult specialist for guidance on dose; children: 100-200 mg/kg/day intravenously given in divided doses every 6 hours; adults: 2 g intravenously every 4 hours

Secondary options

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

and

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

methicillin-susceptible

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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

Back

1st line –

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][65]

Treatment course: depends on microbiologic response of cerebrospinal fluid and underlying illness.

Primary options

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

Secondary options

meropenem: neonates: consult specialist for guidance on dose; children: 120 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1-2 g intravenously every 8 hours

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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

Back

1st line –

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][65]

Treatment course: depends on microbiologic response of cerebrospinal fluid and underlying illness.

Primary options

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

Secondary options

linezolid: neonates: consult specialist for guidance on dose; children: 20-30 mg/kg/day intravenously given in divided doses every 8-12 hours; adults: 600 mg intravenously every 12 hours

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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

Back

1st line –

targeted antibiotic therapy

Treatment course: depends on microbiologic response of cerebrospinal fluid and underlying illness.

Primary options

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

Secondary options

linezolid: neonates: consult specialist for guidance on dose; children: 20-30 mg/kg/day intravenously given in divided doses every 8-12 hours; adults: 600 mg intravenously every 12 hours

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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

Back

1st line –

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][65]

Treatment course: 21 days.

Primary options

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

and

ceftazidime sodium: neonates: consult specialist for guidance on dose; children: 150 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1-2 g intravenously every 8 hours

Secondary options

meropenem: neonates: consult specialist for guidance on dose; children: 120 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1-2 g intravenously every 8 hours

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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

Back

1st line –

targeted antibiotic therapy

Treatment course: 21 days.

Primary options

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

and

ampicillin: neonates: consult specialist for guidance on dose; children: 100-200 mg/kg/day intravenously given in divided doses every 6 hours; adults: 2 g intravenously every 4 hours

Secondary options

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

and

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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

Back

1st line –

targeted antibiotic therapy

Treatment course: 21 days.

Primary options

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

and

meropenem: neonates: consult specialist for guidance on dose; children: 120 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1 g intravenously every 8 hours

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

penicillin-susceptible

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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

Back

1st line –

targeted antibiotic therapy

Treatment course: 7 days.

Primary options

ampicillin: neonates: consult specialist for guidance on dose; children: 100-200 mg/kg/day intravenously given in divided doses every 6 hours; adults: 2 g intravenously every 4 hours

Secondary options

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

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

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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

penicillin-intermediate sensitivity

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

Vasopressors (e.g., epinephrine, norepinephrine, milrinone, dopamine) should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.

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.

Back

1st line –

targeted antibiotic therapy

Treatment course: 7 days.

Primary options

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

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

Secondary options

meropenem: neonates: consult specialist for guidance on dose; children: 120 mg/kg/day intravenously given in divided doses every 8 hours; adults: 1-2 g intravenously every 8 hours

chloramphenicol: neonates: consult specialist for guidance on dose; children and adults: 50-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4000 mg/day

Back

Plus –

supportive therapy

Treatment recommended for ALL patients in selected patient group

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