What is antibiotic treatment for bacterial meningitis in areas with a low prevalence of drug-resistant Streptococcus pneumoniae (DRSP)?

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

In areas with a low prevalence of DRSP, cefotaxime or ceftriaxone plus ampicillin is recommended. 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

  • Ampicillin – 50 mg/kg IV every 6 hours

Adult dosing is as follows:

  • Cefotaxime – 2 g IV every 4 hours

  • Ceftriaxone – 2 g IV every 12 hours

  • Ampicillin – 50 mg/kg IV every 6 hours

An alternative (which may also be chosen if the patient is severely penicillin-allergic) is chloramphenicol (12.5 mg/kg IV every 6 hours) plus trimethoprim-sulfamethoxazole (TMP-SMX; TMP 5 mg/kg IV every 6 hours) or meropenem (pediatric dose, 20-40 mg/kg IV every 8 hours; adult dose, 1 g IV every 8 hours).


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