SOP: emergency workup in patients with suspected acute bacterial meningitis

Table 2 Empiric antibiotic therapy in acute bacterial meningitis (according to [3, 4])

Clinical Situation	Empiric antibiotic therapy	Dosage
Community-acquired	ceftriaxone plus ampicillin^a (plus vancomycin^b)	2x2g/day i.v. 6x2g/day i.v. 2x1g/day i.v. (check serum concentration)
Nosocomial	Meropenem plus vancomycin alternative option: ceftazidime plus vancomycin	3x2g/day i.v. 2x1g/day i.v. (check serum concentration) 3x2g/day i.v. 2x1g/day i.v. (check serum concentration)
Immunocompromised patients	ceftriaxone plus ampicillin plus vancomycin^b	2x2g/day i.v. 6x2g/day i.v. 2x1g/day i.v. (check serum concentration)

^aIn case of penicillin allergy, the use of meropenem is recommended instead (3x2g/day i.v)
^bIn case of a high prevalence of S. pneumoniae that are resistant to 3rd generation cephalosporines (see recommendations of local authorities). As an alternative to vancomycin, rifampicin (1x600mg/day i.v.) can be administered

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