VII. BACTERIAL MENINGITIS:
• Ceftriaxone 2gm q 12h, PLUS Vancomycin 1gm q 8h. If age > 50 yr, ADD Ampicillin 2gm q 4h (or, TMP/SMX 5mg/kg q 8h if PCN allergic) for activity against Listeria.
• If LP delayed for CT scan, give first dose of
antibiotics and Decadron PRIOR to CT scan.
• Vancomycin trough 15-20ug/ml.
• If no prior antibiotics and CSF: cloudy, WBC > 1000, or gram stain (+), give Decadron 10mg
q 6h x 4 days (first dose of must be given 10-
20min before, or concommitant with first dose
of antibiotic).
• Stop Decadron after initial empiric dose if CSF indices and gram-stain do not suggest a bacterial etiology.
• Stop Vancomycin as soon as pneumococcal susceptibility to penicillin is proven, or at 48h if cultures negative for pneumococcus.