Meningitis,Less than 4 weeks of age

Listeria: treat with ampicillin plus gentamicin for minimum 21 days.

GBS: treat with penicillin. Add gentamicin for the first

5-7 days or until sterilization of CSF is confirmed upon repeat LP.
Some experts recommend documentation of CSF sterilization at 24-48 h after initiation of therapy.

Gram negative bacilli: usually are treated with a cefotaxime

initially in combination with

gentamicin. Once sterility of the CSF is documented(repeat CSF culture at 24-48 h is recommended), gentamicin can be discontinued and the appropriate beta-lactam continued to complete a minimum of 21 days or at least 14 days of therapy after the CSF is sterile, whichever is longer. If course is complicated a longer treatment duration may be warranted. CONSULT INFECTIOUS DISEASES.