Antibiotic choice is affected by complicated factors:
- etiologic bacterial species
- blood-brain barrier penetration
- antibacterial activity within purulent CSF
- drug metabolism
- potential drug interactions
- host defense status
The following general guidelines are well developed, however:
| Organism | Antibiotic |
| Streptococcus pneumoniae | |
| Penicillin-sensitive | Penicillin G or ampicillin |
| Partial penicillin-sensitive | Third-generation cephalosporin |
| Penicillin-resistant | Vancomycin + third-generation cephalosporin |
| Neisseria meningitidis | Penicillin G or ampicillin |
| Haemophilus influenzae | |
| Beta-lactamase negative | Ampicillin |
| Beta-lactamase positive | Third-generation cephalosporin |
| Enterobacteriaceae | Third-generation cephalosporin |
| Pseudomonas aeruginosa | Ceftazidime |
| Listeria monocytogenes | Penicillin G or ampicillin |
| Staphylococcus aureus | |
| Methicillin-sensitive | Nafcillin or oxacillin |
| Methicillin-resistant | Vancomycin |
| Staphylococcus epidermidis | Vancomycin |
Table adapted from KL Roos, AR Tunkel, WM Scheld. Acute bacterial meningitis in children and adults. In WM Scheld, RJ Whitley, DT Durack (eds), Infections of the Central Nervous System. Philadelphia: Lippincott–Raven, 1997;336–401.
Adapted from: Goldstein MA and Harden CL. Infectious states. In: Ettinger AB and Devinsky O, eds. Managing epilepsy and co-existing disorders. Boston: Butterworth-Heinemann; 2002;83-133.
With permission from Elsevier (www.elsevier.com).
Reviewed By:
Steven C. Schachter, MD
on:
Monday, March 1, 2004
