What is the treatment for bacterial meningitis in children and adults aged 7-50 years?

Updated: Jul 16, 2019
  • Author: Rodrigo Hasbun, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Answer

In an older child or an otherwise healthy adult (age 7-50 years), the most common microorganisms in bacterial meningitis are S pneumoniae, N meningitidis, and L monocytogenes. In areas where the prevalence of DRSP is greater than 2%, primary treatment consists of with either cefotaxime or ceftriaxone plus vancomycin. Pediatric dosing is as follows:

  • Cefotaxime – 50 mg/kg IV every 6 hours, up to 12 g/day

  • Ceftriaxone – 75 mg/kg initially, then 50 mg/kg every 12 hours, up to 4 g/day

  • Vancomycin – 15 mg/kg IV every 8 hours

Adult dosing is as follows:

  • Cefotaxime – 2 g IV every 4 hours

  • Ceftriaxone – 2 g IV every 12 hours

  • Vancomycin – 750-1000 mg IV every 12 hours or 10-15 mg/kg IV every 12 hours

Some experts add rifampin (pediatric dose, 20 mg/kg/day IV; adult dose, 600 mg/day orally). If Listeria is suspected, ampicillin (50 mg/kg IV every 6 hours) is added.


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