| Age group / Clinical situation | Likely pathogens | Recommended probabilistic antibiotics | Duration |
|---|---|---|---|
| Neonates (< 1 month) | Group B Streptococcus (Streptococcus agalactiae), E. coli, Klebsiella species | Ampicillin + Cefotaxime | 14-21 days (Pathogen-dependent) |
| Listeria monocytogenes | + Gentamicin (5D) if argument | 14-21 days (Pathogen-dependent) | |
| Young infants (1-3 months) | Group B Streptococcus, Streptococcus pneumoniae, Neisseria meningitidis, E. coli | Ampicillin + Cefotaxime | 14-21 days (Pathogen-dependent) Streptococcus pneumoniae, Neisseria meningitidis: consider switch for ampicillin after antibiogram results and MIC |
| Listeria monocytogenes | + Gentamicin (5D) if argument | 14-21 days (Pathogen-dependent) Streptococcus pneumoniae, Neisseria meningitidis: consider switch for ampicillin after antibiogram results and MIC |
|
| Older infants and children (>3 months) | Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b (if unvaccinated) | Ceftriaxone or Cefotaxime | 7-10 days (Neisseria meningitidis, Haemophilus influenzae) or 10-14 days (Streptococcus pneumoniae) Streptococcus pneumoniae, Neisseria meningitidis: consider switch for ampicillin after antibiogram results and MIC |
| Suspected Listeria monocytogenes (any age) | Listeria monocytogenes | Ampicillin + Gentamicin (5D) | 14-21 days |
| Penicillin allergy (Severe) | MRSA, Gram positiveGram-negative Listeria | Vancomycin + Rifampin Ciprofloxacin: Gram-negative Trimethoprim-Sulfamethoxazole |
Pathogen-specific |
Dexamethasone injection: 0.15 mg/kg every 6 hours, for 4 days
NOT in immunocompromised
Just before or at the same time as the first injection of antibiotics in case of:
- A suspicion of bacterial meningitis without microbiological confirmation, but with an empirical antibiotic therapy decision taken in infants aged between 3 and 12 months. This scenario is observed when the indication for brain imaging delays the lumbar puncture (neurological contraindications to the lumbar puncture).
- The lumbar puncture is contraindicated for non-neurological reasons.
- Turbid or even purulent CSF is observed at lumbar punctures.
- A negative direct examination of CSF is observed at lumbar puncture, but other CSF and blood biological findings confirm the bacterial meningitis diagnosis.
- Initial microbiological diagnosis indicative of pneumococcal bacterial meningitis or H. influenzae bacterial meningitis and should be discontinued when bacterial meningitis is ruled out or when meningococcal or Listeria meningitis is confirmed.
Dosage
- First week of life (7 days or less): 100 mg/kg/dose 8 hourly
- 8 days : 200mg/kg/d
Cefotaxime
- First week of life (7 days or less): 50 mg/kg/dose 12 hourly
- 8-20 days: 50 mg/kg/dose 8 hourly
- 21 days & older: S.pneumoniae or before identification when a bacterial meningitidis is suspected
- 300 mg/kg/day; maximum daily dose 12g
- Continuous infusion or a discontinuous infusion with a minimum of four infusions (75 mg/kg/6 hrs). The daily dose for the continuous infusion is initiated immediately after the administration of a loading dose of 50 mg/kg over one hour.
- E coli, N. meningitidis: 200 mg/kg/day is recommended. The administration is performed intravenously either with a continuous infusion or a discontinuous infusion with a minimum of four infusions (50 mg/kg/6 hrs). The daily dose for the continuous infusion is administered concomitantly with the loading dose of 50 mg/kg over one hour.
Ceftriaxone
- S.pneumoniae
- or before identification when a bacterial meningitidis is suspected: 50 mg/kg/12h, maximum 4g
- E coli, N.meningitidis: 75 mg/kg/day as one or two intravenous infusions.
Gentamicin
- 5–8 mg/kg once daily, 5 days in case of listeria
Rifampin
- 10 mg/kg, twice daily, up to 600 mg/day
Vancomycin
- Loading dose of 30 mg/kg over one hour and then daily dose of 40-60 mg/kg/day to be adjusted to obtain residual plasma concentrations between 15 and 20 mg/L