Початкові антибіотики при гострому бактеріальному менінгіті
Patient Group | Suspected Bacteria | Provisional Antibiotics |
|---|---|---|
Age | ||
< 3 months | Streptococcus agalactiae Escherichia coli or other gram-negative bacteria Listeria monocytogenes Staphylococcus aureus* | Ampicillin plus Ceftriaxone or cefotaxime |
3 months–18 years | Neisseria meningitidis S. pneumoniae S. aureus* Haemophilus influenzae† | Cefotaxime or ceftriaxone plus Vancomycin |
18–50 years | S. pneumoniae N. meningitidis S. aureus* | Ceftriaxone or cefotaxime plus Vancomycin |
> 50 years | S. pneumoniae L. monocytogenes S. aureus Gram-negative bacteria N. meningitidis (unusual in this age group) | Ceftriaxone or cefotaxime plus Ampicillin plus Vancomycin |
Route | ||
Sinusitis, otitis, CSF leaks | S. pneumoniae‡ H. influenzae Gram-negative bacteria including Pseudomonas aeruginosa Anaerobic or microaerophilic streptococci Bacteroides fragilis S. aureus* | Vancomycin plus Ceftazidime or meropenem plus Metronidazole |
Penetrating head wounds, neurosurgical procedures, shunt infections | S. aureus S. epidermidis Gram-negative bacteria including P. aeruginosa S. pneumoniae | Vancomycin plus Ceftazidime |
Immune status | ||
AIDS, other conditions that impair cell-mediated immunity | S. pneumoniae L. monocytogenes Gram-negative bacteria including P. aeruginosa S. aureus* | Ampicillin plus Ceftazidime plus Vancomycin |
* S. aureus is an uncommon cause of meningitis except when the route is a penetrating head wound or a neurosurgical procedure. However, it can cause meningitis in all patient groups. Thus, vancomycin or other antistaphylococcal antibiotics should be given if clinicians think that these bacteria are a possible, even if unlikely, cause. | ||
† H. influenzae should be considered in children < 5 years with no record of H. influenzae type b conjugate vaccination. | ||
‡ S. pneumoniae is the most common causative bacteria in patients with a CSF leak or acute otitis. Such patients may be treated with vancomycin and ceftriaxone or cefotaxime. However, when meningitis is accompanied by subdural empyema or develops after a neurosurgical procedure, other bacteria, such as P. aeruginosa or Bacteroides, may also be present; in such cases, initial treatment should include vancomycin plus ceftazidime plus metronidazole. Subdural empyemas should be promptly drained. | ||
CSF = cerebrospinal fluid. | ||