Gram-negative bacilli (Neonates)

Duration of Therapy

21 Days

Duration in the neonate is 2 weeks beyond the first sterile CSF culture or greater than or equal to 3 weeks, whichever is longer.

Recommended Regimen

Cefotaxime

Note:

Cefotaxime used instead of Ceftriaxone due to:

Risk of bilirubin encephalopathy in neonates or preterm infants less than 1 month corrected age
Interaction with calcium-containing IV infusions, including TPN in neonates and preterm infants less than 1 month corrected age

0-7 days

Less than 2 kg:
50 mg/kg IV/IM q12h

Greater than 2 kg:
50 mg/kg IV/IM q8h-q12h

8-28 days

Less than 1.2 kg:
50 mg/kg IV/IM q12h

Between 1.2-2 kg:
50 mg/kg IV/IM q8h

Greater than 2 kg:
50 mg/kg IV/IM q6h-q8h

If Pseudomonas

Ceftazidime

0-7 Days

Less than 2kg
50mg/kg/dose IV/IM q12h

Greater than 2kg
50mg/kg/dose IV/IM q8h-q12h

8-28 Days

Less than 1.2kg
50mg/kg/dose IV/IM q12h

Greater than 1.2kg
50mg/kg/dose IV/IM q8h

If Beta-lactam Allergy

Trimethoprim-Sulfamethoxazole

Use in infants less than 2 months remains controversial – most experts believe there is no risk of kernicterus in well patients greater than 4 weeks of age, and many would also use in infants 2-4 weeks old with no signs of jaundice

Penicillin/Beta-lactam Allergy

If the patient has a true history of IgE mediated penicillin or beta-lactam allergy, the risks versus benefit of empiric treatment of suspected meningitis with appropriate antimicrobials should be discussed.