Home > Treatment Recommendations > Adult Patients > Central Nervous System > Meningitis > Adult > 50 years or Immunocompromised (including AIDS), Alcohol abuse, Debilitating illness, Pregnancy

Adult > 50 years or Immunocompromised (including AIDS), Alcohol abuse, Debilitating illness, Pregnancy

- Cephalosporins have no activity against Listeria.

- HIV individuals - need to rule out:

Cryptococcosis
M. tuberculosis
Syphilis
Toxoplasmosis

Usual Pathogens

S. pneumoniae
Listeria monocytogenes
N. meningitidis
Enterobacterales

Empiric Therapy	Dose	Duration
Dexamethasone	10mg IV q6h	If S. pneumoniae or H. influenzae, or no pathogen identified - 4 days. If neither S. pneumoniae nor H. influenzae, discontinue dexamethasone. If Listeria, discontinue dexamethasone immediately as associated with increased mortality.
+
Ceftriaxone	2g IV q12h	See Duration
+
Ampicillin	2g IV q4h
+
Vancomycin	15mg/kg IV q8-12h

Ampicillin/penicillin and/or ceftriaxone allergy

Empiric Therapy	Dose	Duration
Dexamethasone	10mg IV q6h	If S. pneumoniae or H. influenzae, or no pathogen identified - 4 days. If neither S. pneumoniae nor H. influenzae, discontinue dexamethasone. If Listeria, discontinue dexamethasone immediately as associated with increased mortality.
+
Meropenem	2g IV q8h	See Duration
+
TMP/SMX	15-20mg TMP/kg/day IV div q6-8h
+
Vancomycin	15mg/kg IV q8-12h

Severe penicillin, ceftriaxone, and carbapenem allergy

Empiric Therapy	Dose	Duration
Dexamethasone	10mg IV q6h	If S. pneumoniae or H. influenzae, or no pathogen identified - 4 days. If neither S. pneumoniae nor H. influenzae, discontinue dexamethasone. If Listeria, discontinue dexamethasone immediately as associated with increased mortality.
+
Vancomycin	15mg/kg IV q8-12h	See Duration
+
TMP/SMX	15-20mg TMP/kg/day IV div q6-8h