Guidelines for the Early Clinical and Public Health Management of ...

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Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) Table 3.2. Antibiotics - Age related doses (mg/kg/dose) and frequency Age Drug mg/kg/dose Frequency according to age 0 - 1 mos Amoxicillin 100mg/kg 28 days: every 4 hrs 7 days: every 8 hrs Rifampicin 5 PO < 28 days: 5 mg/kg > 28 days - 12 years: 10 mg/kg Adult: 600 mg every 12 hrs every 12 hrs For explanatory footers see below: 1. In neonatal meningitis, when the susceptibility of the organism is known and the CSF is sterilised, modify antibiotics to the most active and least toxic. For group B streptococcus this is benzylpenicillin, for listeria this is amoxicillin. With Gram negative organisms, choice will depend on susceptibility data. Frequency of dosing may need to be modified for premature infants. -34-
Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease) 2. Ceftriaxone • Is contraindicated in newborns up to 28 days of age if they require (or are expected to require) IV calcium treatment, or calcium-containing infusions because of the risk of precipitation of ceftriaxone-calcium. • In patients of any age must not be mixed or administered simultaneously with any calcium-containing IV solutions, even via different infusion lines or at different infusion sites. • In patients > 28 days, calcium-containing solutions may be administered sequentially if infusion lines at different sites are used or if the infusion lines are replaced or thoroughly flushed between infusions with physiological salt-solution to avoid precipitation. • In patients requiring continuous infusion with calcium-containing TPN solutions, healthcare professionals may wish to consider the use of alternative antibacterial treatments which do not carry a similar risk of precipitation. 3. A clear history of penicillin anaphylaxis is a contraindication to use of penicillin or cephalosporins. A history of non-urticarial skin rash or gastrointestinal upset is not a contraindication to penicillin therapy. Meropenem is indicated if there is a history of penicillin anaphylaxis. 4. If initial CSF Gram stain show Gram positive cocci, consistent with pneumococcal meningitis, add vancomycin pending confirmation of sensitivity of isolate to penicillin and cephalosporins 5. If dexamethasone has been given and resistant pneumococcal meningitis likely, add rifampicin, as dexamethasone can reduce CSF penetration of vancomycin. The recommended duration of treatment for specific infections is specified in Table 3.4. Table 3.4. Minimum duration of IV antibiotic therapy (total course must be given IV*) Bacterial meningitis (organism specific) Uncomplicated meningococcal infection Uncomplicated Haemophilus infection Uncomplicated pneumococcal infection Group B streptococcal infection Listeria infection Aerobic Gram negative infection Duration IV antibiotic therapy (days) 7 days 10 days 14 days 14-21 days 21 days 21 days (min 21 days or 14 days post sterilisation of CSF, whichever is longer) *IV; Intravenously -35-
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