Background

The given list is used as an empiric therapeutic regimen to treat bacterial meningitis. All the drugs are administrated IV. 

Age: Less than 1 month 

Pathogens which are commonly observed are group B streptococcus (GBS) (symptoms like neck stiffness), E.Coli. Klebsiella species, and Listeria monocytogenes. 

Ampicillin with a dosage of 100 mg/kg with aminoglycoside (tobramycin or gentamicin 2.5 mg/kg) for every 8 hours or 

Ampicillin with a dosage of 100mg/kg with cefotaxime with a dosage of 50 mg/kg for every 6 hours 

Cefotaxime with dosage of 50 mg/kg for every 8 hours 

Age: 1 to 23 months 

Pathogens which are commonly observed are Streptococcus pneumoniae, Group B streptococcus (GBS), E. Coli, Haemophilus influenzae type b, and Neisseria meningitidis (Symptoms like skin rash with infection of Meningococcus species, immediate treatment of cefotaxime, benzylpenicillin, or ceftriaxone). 

Vancomycin with dosage of 15 mg/kg for every 8 hours with 3rd generation of cephalosporin (cefotaxime with dosage of 75 mg/kg to 100 mg/kg for every 6 to 8 hours or ceftriaxone with dosage of 75 mg/kg to 100 mg/kg for every 12 to 24 hours) 

Age: 2 to 50 years 

Pathogens that are commonly observed are S. pneumoniae and N. meningitides. Pediatric and adult doses must be included with vancomycin with 3rd generation of cephalosporin (cefotaxime or ceftriaxone). 

Children: Vancomycin with dosage of 15 mg/kg for every 6 hours with ceftriaxone with dosage of 75 mg/kg to 100 mg/kg for every 12 hours to 24 hours, or cefotaxime with dosage of 75 mg/kg to 100 mg/kg for every 6 to 8 hours 

Adult: Vancomycin with dosage of 15 mg/kg for every 8 hours (trough level15 to 20 ug/mL) with cefotaxime with dosage of 2 g for every 4 hours or ceftriaxone 2 g for every 12 hours 

Age: Above 50 years 

Pathogens that are commonly observed are aerobic gram-negative rods, S pneumoniae, L monocytogenes, and N meningitidis. 

Vancomycin with dosage of 15 mg/kg for every 8 hours (trough level 15 to 20 ug/mL) with 3rd generation of cephalosporin cefotaxime with dosage of 2 g for every 4 hours to 6 hours or ceftriaxone with dosage of 2 g for every 12 hours along with ampicillin 2 g for every 4 hours if Listeria is confirmed 

Predisposed condition 

Pregnancy: 

Pathogens which are commonly observed are L monocytogenes. 

Ampicillin with 2 g of dosage for every 4 hours or penicillin G with 4 mU of dosage for every 4 hours 

Immunocompromised disease (Steroids or chemotherapy): 

Pathogens that are commonly observed are Listeria species, S pneumoniae, anaerobic gram-negative bacilli, and N meningitidis. 

Vancomycin with 15 mg/kg dosage for every 9 hours (trough level 15 to 20 ug/mL) with ampicillin with 2 g of dosage for every 4 hours with 3rd generation of cephalosporin (cefotaxime with 2 g of dosage for every 4 to 6 hours or ceftriaxone with 2 g of dosage for every 12 hours) 

Fracture of basilar skull: 

H influenzae, S pneumoniae, and Streptococcus pyogenes. 

Vancomycin with 15 mg/kg dosage for every 8 hours (trough level 15 to 20 ug/mL) with 3rd generation of cephalosporin (cefotaxime with 2 g of dosage for every 4 to 6 hours or ceftriaxone with 2 g of dosage for every 12 hours) 

Post neurosurgery or penetrating trauma: 

Pathogens that are commonly observed are Staphylococcus epidermidis, Staphylococcus aureus, and aerobic gram-negative bacillus. 

Vancomycin with 15 mg/kg dosage for every 8 hours (trough level 15 to 20 ug/mL) with ceftazidime or meropenem or cefepime with 2 g of dosage for every 8 hours 

Cerebrospinal fluid shunt: 

Pathogens which are commonly observed are S Propionibacterium acnes, S. aureus, aerobic gram-negative bacillus, S. epidermidis. 

Vancomycin with 15 mg/kg dosage for every 8 hours (trough level 15 to 20 ug/mL) with ceftazidime or meropenem or cefepime with 2 g of dosage for every 8 hours 

Epidemiology

Anatomy

Pathophysiology

Etiology

Genetics

Prognostic Factors

Clinical History

Physical Examination

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Differential Diagnoses

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

Medication

Future Trends

Media Gallary

References

https://www.ncbi.nlm.nih.gov/books/NBK470351/ 

https://www.ncbi.nlm.nih.gov/books/NBK459360/ 

https://pubmed.ncbi.nlm.nih.gov/30387309/