Bacterial Meningitis Organism-Specific Therapy 

Updated: Oct 20, 2015
  • Author: Darvin Scott Smith, MD, MSc, DTM&H; Chief Editor: Michael Stuart Bronze, MD  more...
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Specific Organisms and Therapeutic Regimens

Organ-specific therapeutic regimens for bacterial meningitis are outlined below, including those for Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Listeria monocytogenes, Streptococcus agalactiae, Enterobacteriaceae organisms, and Pseudomonas aeruginosa. [1]

Streptococcus pneumoniae

Penicillin sensitivity:

  • Penicillin G 4 million U IV q4h or  ampicillin 2 g IV q4-6h [MIC < 0.1 mcg/mL]
  • Ceftriaxone 2 g IV q12h or  cefotaxime 2 g IV q4-6h [MIC 0.1-1 mcg/mL]
  • (Ceftriaxone 2 g IV q12h or  cefotaxime 2 g IV q4-6h) plus  vancomycin 15 mg/kg IV q8-12h [MIC ≥2 mcg/mL]
  • Duration of therapy: 10-14d

Ceftriaxone sensitivity:

  • (Ceftriaxone 2 g IV q12h or  cefotaxime 2 g IV q4-6h) plus  (vancomycin 15 mg/kg IV q8-12h or  rifampin 600 mg PO/IV qd) [MIC ≥ 1 mcg/mL]
  • Duration of therapy: 10-14d

Haemophilus influenzae

Beta-lactamase-negative:

  • Ampicillin 2 g IV q4-6h
  • Duration of therapy: 7d

Beta-lactamase-positive:

  • Ceftriaxone 2 g IV q12h or cefotaxime 2 g IV q4-6h
  • Duration of therapy: 7d

Neisseria meningitidis

See the list below:

  • Penicillin G 4 million U IV q4h or ampicillin 2 g IV q4-6h
  • Ceftriaxone 2 g IV q12h or cefotaxime 2 g IV q4-6h
  • Duration of therapy: 7d

Listeria monocytogenes

See the list below:

  • (Penicillin G 4 million U IV q4h or  ampicillin 2 g IV q4-6h) plus  gentamicin 3-5 mg/kg IV daily divided q8h
  • Duration of therapy: ≥ 21d

Streptococcus agalactiae

See the list below:

  • Penicillin G 4 million U IV q4h plus gentamicin 3-5 mg/kg IV daily, divided q8h, if warranted
  • Duration of therapy: 14-21d

Enterobacteriaceae organisms

See the list below:

  • (Ceftriaxone 2 g IV q12h or  cefotaxime 2 g IV q4-6h) plus gentamicin 3-5 mg/kg IV daily divided q8h
  • Duration of therapy: 21d

Pseudomonas aeruginosa

See the list below:

  • ( Ceftazidime 1 g IV q8h or  cefepime 2 g IV q8h) plus gentamicin 3-5 mg/kg IV daily divided q8h
  • Duration of therapy: 21d