Page 63 - HPP ANTIMICROBIAL GUIDELINE 2018

CENTRAL NERVOUS INFECTIONS
Suggested Treatment
Infection/ Condition Comments
Preferred Alternative

Acute bacterial meningitis Ceftriaxone 2gm IV q12h Cefotaxime 2gm IV q6h Consider empirical cover for
listeriosis in patient >60 years old
and the course of disease is
Duration of treatment : 10-14 days indolent.

Streptococcus pneumoniae

Penicillin sensitive strains Benzylpenicillin 4MU IV q4h All attempts should be made to
(MIC < 0.12 mcg/ml) ascertain the MIC of isolated
pneumococcus
Penicillin resistant strains Ceftriaxone 2gm IV q12h
(MIC > 0.12 mcg/ml) Ceftriaxone or cefotaxime should be
OR de-escalated to benzylpenicillin once
Cefotaxime 2gm IV q6h the MIC result is known

Penicillin resistant strains Vancomycin 25-30mg/kg loading Duration of treatment:
(≥2 mcg/ml) dose then 15mg/kg IV q12h 10-14 days
(not to exceed 2gm per dose) (depending on clinical response)

PLUS

Ceftriaxone 2gm IV q12h
OR
Cefotaxime 2gm IV q6h

Neisseria meningitidis
MIC to penicillin < 0.1 mcg/ml Benzylpenicillin 4MU IV q4h Duration of treatment is 7 days
(depending on clinical response)
MIC to penicillin is > 0.1 mcg/ml Ceftriaxone 2gm IV q12h Cefotaxime 2gm IV q6h

HPP AMG Central Nervous Infections 26