Antibiotics - Neurological

Infection

Adult Meningitis

Ceftriaxone 2g q12h iv.

If Listeria monocytogenes meningitis suspected* add amoxicillin 2g q4h iv.

If resistant S. pneumoniae suspected** or TB meningitis suspected*** seek specialist advice.

Seek advice from microbiology.

1. No Hx anaphylaxis with penicillins: Ceftriaxone 2g q12h iv
2. Hx of anaphylaxis with penicillins: Meropenem 2g q8h iv. NB use with caution as there is a risk of allergic reaction with meropenem.
3. Hx of anaphylaxis with penicillins / meropenem: Chloramphenicol 25mg/kg q6h iv
   plus
   Vancomycin 25mg/kg (max 2g) loading dose then 15mg/kg q12h iv

Review high dose chloramphenicol as soon as clinically indicated.

7 days for N. meningitidis.

10 days for H. influenzae.

14 days for S. pneumoniae.

21 days for Listeria monocytogenes

TB meningitis – seek advice on treatment and duration from microbiology and ID specialists.

Treatment should not be delayed pending investigations.

Specimens for collection:
blood: for culture, glucose and EDTA blood for meningococcal & pneumococcal PCR.
CSF: for microscopy and culture, glucose estimation, protein and PCR.
Throat swab for culture: labelled '? N. meningitidis'.

Once pathogen is identified, treatment should be tailored to the narrowest spectrum agent that is sensitive. Always seek microbiology advice.

Do not switch to oral therapy.

If Vancomycin used, maintain pre-dose levels 15-20mg/L.

* Risk factors for Listeria monocytogenes: age >50 years, immunosuppressed, alcohol abuse, pregnancy, malignancy.

** Risk factors for resistant S. pneumoniae: age <10 or >50 years, immunosuppressed, prolonged hospital stay, frequent, prolonged or prophylactic antibiotic use, recent visit to country with high rates of resistant S. pneumoniae, e.g. Spain.

Risk factors for TB meningitis: homelessness, alcohol abuse, immunosuppressed, recent immigration, recent contact with index case.

Infection

Encephalitis

Aciclovir 10mg/kg q8h iv. Use Ideal Body Weight to calculate Aciclovir dose.

14-21 days.

Send CSF for HSV PCR.

Adjust dose in renal impairment.

IBW

IBW ♂ = 50kg + [(height (cm) -154) x0.9]

IBW ♀ = 45.5kg + [(height (cm) -154) x0.9]

Infection

Post neurosurgery / CSF shunt

Staph aureus, Coagulase negative staph, Gram negative bacilli

Vancomycin 25mg/kg (max 2g) iv loading dose then 15mg/kg q12h iv
plus
Cefriaxone 2g q12h iv.

Rash only:

Vancomycin 25mg/kg loading dose then 15 15mg/kg q12h
plus
Ceftriaxone 2g q12h iv.

Hx anaphylaxis:

Seek advice from microbiology.

Vancomycin Loading Dose then 15mg/kg q12h iv
plus
Ceftazidime 2g q8h iv.

Seek advice from microbiology in severe penicillin allergy.

Vancomycin: maintain pre-dose levels 15-20mg/L. Seek advice from microbiology.