ceftriaxone |
IV 2 g every twelve hours |
If risk of listeria (alcoholic, diabetic, > 50 years, pregnant, or immunosuppressed):
ADD
amoxicillin |
IV 2 g every four hours |
If risk of S. pneumoniae (known or suspected otitis media or sinusitis, recent treatment with a beta-lactam, Gram-positive cocci seen on Gram stain, or pneumococcal antigen assay of CSF is positive):
ADD
vancomycin |
See dosing guidelines (use high doses). |
moxifloxacin |
IV 400 mg every 24 hours (once a day) |
Alternative regimen:
ciprofloxacin |
IV 400 mg every eight hours |
AND
vancomycin |
See dosing guidelines (use high doses). |
If risk of listeria (alcoholic, diabetic, > 50 years, pregnant, or immunosuppressed):
ADD
trimethoprim+sulfamethoxazole (co-trimoxazole) |
IV 5 mg/kg (trimethoprim component) every six hours (round dose down to the nearest whole vial) |
If susceptible to penicillin and the patient does not have a penicillin allergy:
benzylpenicillin (Penicillin G) |
IV 2.4 g (4 megaunits) every four hours |
Mild penicillin allergy
ceftriaxone |
IV 2 g every twelve hours |
If resistant to penicillin or severe penicillin allergy:
vancomycin |
See dosing guidelines (use high doses). |
ceftriaxone |
IV 2 g every twelve hours |
Severe penicillin allergy
Consult Infectious Diseases/Clinical Microbiology
For clearance of nasopharyngeal N. meningitidis from patient and contacts:
ciprofloxacin |
PO 500 mg single dose |
OR
ceftriaxone |
IM 250 mg single dose |
amoxicillin |
IV 2 g every four hours |
Penicillin allergy
trimethoprim+sulfamethoxazole (co-trimoxazole) |
IV 5 mg/kg (trimethoprim component) every six hours (round dose down to the nearest whole vial) |
Topic Code: 99219