Специфічні антибіотики при гострому бактеріальному менінгіті
Bacteria | Age Group | Antibiotics* | Comments |
|---|---|---|---|
Gram-positive bacteria (unidentified) | Children and adults | Vancomycin plus Ceftriaxone (cefotaxime) and ampicillin† | — |
Gram-negative bacilli (unidentified) | Children and adults | Cefotaxime (or ceftriaxone, meropenem, or ceftazidime) plus Gentamicin, tobramycin, or amikacin‡ if systemic infection is suspected | — |
Haemophilus influenzae type b | Children and adults | Ceftriaxone (cefotaxime) | — |
Neisseria meningitidis | Children and adults | Ceftriaxone (cefotaxime) | Penicillin G is used for susceptible strains after sensitivities are known. |
Streptococcus pneumoniae | Children and adults | Vancomycin plus ceftriaxone or cefotaxime | Penicillin G may be used for susceptible strains after sensitivities are known. Vancomycin covers strains that are highly resistant to penicillin and that ceftriaxone and cefotaxime may not cover. These strains can account for up to 50% of community-acquired infections. |
Staphylococcus aureus and S. epidermidis | Children and adults | Vancomycin with or without rifampin | Vancomycin is used for methicillin-resistant strains, or nafcillin or oxacillin may be used after sensitivities are known. Rifampin is added if no improvement occurs with vancomycin or nafcillin. |
Listeria species | Children and adults | Ampicillin (penicillin G) or Trimethoprim/sulfamethoxazole | Penicillin G is used for susceptible strains after sensitivities are known. Trimethoprim/sulfamethoxazole is used in patients who are allergic to penicillin. |
Enteric gram-negative bacteria (eg, Escherichia coli, Klebsiella species, Proteus species) | Children and adults | Ceftriaxone (cefotaxime) plus Gentamicin, tobramycin, or amikacin‡ if systemic infection is suspected | — |
Pseudomonas species | Children and adults | Meropenem (ceftazidime or cefepime), usually alone but sometimes with an aminoglycoside or Aztreonam | — |
* Alternative antibiotics are in parentheses. | |||
† If gram-positive bacteria are pleomorphic, ampicillin is included to cover Listeria species. | |||
‡ Amikacin is used in areas where gentamicin resistance is common. Because aminoglycosides have poor cerebrospinal fluid penetration, they are infrequently used for treatment of meningitis. When required, they may have to be given intrathecally or via an Ommaya reservoir, especially in patients with Pseudomonas meningitis. When aminoglycosides are used, renal function should be monitored. | |||