Spectrum: Local Antimicrobial Stewardship, for CHEO-OCTC

Meningitis (infants >1 month)

Infection Prevention and Control

Droplet / Contact Precautions

Until 24 hours of antimicrobial therapy

Exception: For infants < 1 month of age with no respiratory/enteric symptoms, no isolation is required

Most Likely Pathogens

Streptococcus pneumoniae

Neisseria meningitidis

Empiric Antimicrobials*

CefTRIAXone IV

PLUS

Vancomycin IV

*Should be modified according to culture results when available.

Note

Corticosteroids are an option in children ≥ 4 weeks but this is still controversial.

Dexamethasone 0.15 mg/kg (max 10 mg/dose) IV q6h x 4 days if H. influenzae or S. pneumoniae is identified.*

*Ideally give 15 - 20 minutes before or with the dose of antibiotics but if not possible, within 4 hours of start of antibiotics. Discontinue at 48 hours if cultures are negative or other pathogen suspected or identified.

Usual Duration

Minimum 10 to 14 days or longer if complicated