German guidelines on community-acquired acute bacterial meningitis in adults

Table 3 Empiric antibiotic therapy in acute bacterial meningitis in adults

Clinical Condition	Recommended antiobitics
Community-acquired, no immunosuprression	cephalosporine group 3a¹ plus ampicillin²
Post neurosurgery or post brain trauma	vancomycin plus meropenem or vancomycin plus ceftazidime³ (plus metronidazole in case of surgery that include mucous membranes)
Immunosuppression	vancomycin plus meropenem⁴
Shunt-infection	vancomycin plus meropenem or vancomycin plus ceftazidime

¹E.g. ceftriaxone or cefotaxim. ²In regions with a high rate of cephalosporine-resistant pneumococci (e.g. France, Spain, Hungary, Australia, Southern Africa, Northern America initial treatment with a combination of ceftriaxone, vancomycin and ampicillin or ceftriaxone, rifampicin and ampicillin is recommended. ³or vancomycin plus cefepime. In cases of proven ventriculitis due to Staphylococcus aureus, intrathecal vancomycin can be considered [40]. ⁴Dependent on the clinical constellation, coverage of further pathogens (e.g. fungi) can be necessary

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