How should patients with bacterial meningitis be monitored during antibiotic treatment?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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The chosen antibiotic should attain adequate levels in the CSF, and its ability to do so usually depends on its lipid solubility, molecular size, and protein-binding capacity, as well as on the patient’s degree of meningeal inflammation. The penicillins, certain cephalosporins (ie, third- and fourth-generation agents), the carbapenems, fluoroquinolones, and rifampin provide high CSF levels.

Monitoring for possible drug toxicity during treatment (eg, with blood counts and renal and liver function monitoring) is warranted. The antimicrobial dose must be adjusted on the basis of the patient’s renal and hepatic function. At times, obtaining serum drug concentrations may be necessary to ensure adequate levels and to avoid toxicity in drugs with a narrow therapeutic index (eg, vancomycin and aminoglycosides). The patient must also be monitored for complications from the disease (eg, hydrocephalus, seizures, or hearing defects).

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