Patient with Suspected Meningitis Age > 56 days — Recommended Antibiotics — Clinical Pathway: Emergency, Inpatient

Suspected Meningitis Age > 56 days Clinical Pathway — Emergency Department, Inpatient and ICU

Recommended Empiric Antibiotics for Acute Bacterial Meningitis

First-Line Therapy Allergy to First-Line β-Lactam
Assess Need for Alternative		 Comments/Other Considerations
  • Ceftriaxone, IV
    • ≤ 20 kg
      • 50 mg/kg/dose every 12 hours
      • or
      • 100 mg/kg/dose every 24 hours
        (Maximum 2,000 mg/dose)
    • > 20 kg
      • 50 mg/kg/dose every 12 hours
        (Maximum of 2,000 mg/dose)
      • May give up to 2,000 mg every 12 hours
        (Maximum of 4,000 mg/day)
  • AND
  • Vancomycin, IV
    • ≤ 50 kg
      • 15 mg/kg/dose every 6 hours
        (Maximum 750 mg/dose)
    • > 50 kg and/or > 18 years
      • 15 mg/kg/dose every 8 hours
        (Maximum 1,000 mg/dose)
  • Substitute meropenem or levofloxacin
    for ceftriaxone
  • Meropenem, IV
    • ≥ 1 month to < 6 months
      • 40 mg/kg/dose every 8 hours
        (Maximum 2,000 mg/dose)
  • Levofloxacin, IV
    • ≥ 6 month and < 5 years
      • 10 mg/kg/dose IV every 12 hours
        (Maximum 375 mg/dose)
    • ≥ 5 years
      • 10 mg/kg/dose IV every 24 hours
        (Maximum: 750 mg/dose)
    • AND
    • Vancomycin, IV
      • ≤ 50 kg
        • 15 mg/kg/dose every 6 hours
          (Maximum 750 mg/dose)
      • > 50 kg and/or ≥ 18 years
        • 15 mg/kg/dose every 8 hours
          (Maximum 1,000 mg/dose)
  • Give ceftriaxone before vancomycin
  • If CSF Gram stain positive for Gram-negative rods change therapy to meropenem AND vancomycin. ID consult recommended.
    • Meropenem, IV
      • ≥ 1 month and < 50 kg
        • 40 mg/kg/dose every 8 hours
          (Maximum 2,000 mg/dose)
      • ≥ 50 kg and/or ≥ 18 years
        • 2,000 mg every 8 hears
  • Consider acyclovir for suspicion of HSV encephalitis:
    • Acyclovir, IV
      • < 3 months
        • 20 mg/kg/dose every 8 hours
      • ≥ 3 months to < 12 years
        • 15 mg/kg/dose every 8 hours
      • ≥ 12 years
        • 10 mg/kg/dose every 8 hours
    • Note: Acyclovir should be based on Adjusted Body Weight (BW) when Actual BW is 30% greater than Ideal BW.

CHOP Formulary for complete drug information.