Initial antimicrobial therapy is most commonly antibacterial, as most cases of acute meningitis have a bacterial cause. Because the etiology of meningitis varies with patient age, initial empiric therapy should be directed against the expected pathogens but should remain with broad coverage until cultures are definitive.
|Age||First choice||Alternative choice|
|Younger than 6 weeks||
Cefotaxime and ampicillin
Ceftriaxone* and ampicillin
Gentamicin and ampicillin
|Ceftazidime and ampicillin|
|Older than 6 weeks||
Ceftriaxone and vancomycin
Cefotaxime and vancomycin
|Chloramphenicol and ampicillin|
*Ceftriaxone is relatively contraindicated in neonates younger than 1 week of age with hyperbilirubinemia due to possibility of displacement of bilirubin from albumin by drug.
Patients with meningitis may be quite ill, with multisystem abnormalities, including cardiovascular, pulmonary, gastrointestinal, and neurological findings.