Give as soon as possible (if LP performed within 2hr of antibiotics, CSF culture will not be affected)
MRSA is uncommon in the neonate
Ampicillin 75mg/kg IV q6hrs PLUS
Cefotaxime 50mg/kg IV q6hrs OR Gentamicin 2.5mg/kg IV q8hrs
Per AAP, ceftazidime 50mg/kg IV (q12hr for babies < 8 days of age, q8hr for >7 days old) is a reasonable alternative to cefotaxime, offering virtually the same coverage for enteric bacilli and is FDA approved for all age groups
If suspecting S. pneumoniae or MRSA, add Vancomycin
Consider acyclovir for HSV
Per AAP, ceftazidime 50mg/kg IV (q12hr for babies < 8 days of age, q8hr for >7 days old) is a reasonable alternative to cefotaxime, offering virtually the same coverage for enteric bacilli and is FDA approved for all age groups
Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
Vancomycin 15-20 mg/kg IV BID daily
Vancomycin is for resistant Pneumococcus
Vancomycin is for resistant Pneumococcus
Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
Vancomycin 15-20 mg/kg IV BID daily
Vancomycin is for resistant Pneumococcus
Vancomycin is for resistant Pneumococcus
Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
Vancomycin 15-20 mg/kg IV BID daily PLUS
Ampicillin 2gm IV q4h (hourly if listeria suspected)
Vancomycin 15-20mg/kg IV BID daily PLUS
Cefepime 2g (50mg/kg) IV q8 hours daily OR Ceftazidime 2g (50mg/kg) IV q8 hours daily OR Meropenem 2gm (40mg/kg) IV q8 hours daily
Options
Amphotericin B 1mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
Amphotericin B 5mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
Chloramphenicol 1g IV q6h + Vancomycin 15mg/kg q8-12hr
Coverage for skin contaminants (S. epidermis, S. aureus)
Vancomycin plus ceftriaxone plus shunt removal
Ceftriaxone 250mg IM once (if less than 15yr then 125mg IM)
Ciprofloxacin 500mg PO once
Rifampin 600 mg PO BID x 2 days
if < 1 month old then 5mg/kg PO BID x 2 days
if ≥ 1 month old then 10mg/kg (max at 600mg) PO BID x 2 days
if < 1 month old then 5mg/kg PO BID x 2 days
if ≥ 1 month old then 10mg/kg (max at 600mg) PO BID x 2 days
If patient has a cephalosporin allergy, you can replace the third generation cephalosporin with Meropenem or chloramphenicol.
Meningitis
Migraine headache
Encephalitis
Tension headache
Meningoencephalitis
Cluster headache
Neoplastic meningitis
Meningitis/encephalitis