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Antimicrobial therapy for bacterial meningitis in children caused by Streptococcus pneumoniae based upon susceptibility test results in patients begun on vancomycin and either cefotaxime or ceftriaxone

Antimicrobial therapy for bacterial meningitis in children caused by Streptococcus pneumoniae based upon susceptibility test results in patients begun on vancomycin and either cefotaxime or ceftriaxone
Susceptibility test results* Antibiotic management
Susceptible to penicillin

Discontinue vancomycin

AND

Begin penicillin (and discontinue cephalosporin)

OR

Continue ceftriaxone or cefotaxime aloneΔ

Not susceptible to penicillin (intermediate or resistant)

AND

Susceptible to ceftriaxone and cefotaxime

Discontinue vancomycin

AND

Continue ceftriaxone or cefotaxime alone

Not susceptible to penicillin (intermediate or resistant)

AND

Not susceptible to ceftriaxone and cefotaxime (intermediate or resistant)

AND

Susceptible to rifampin

Continue vancomycin

AND

Continue ceftriaxone or cefotaxime

Rifampin may be added in selected circumstances◊
* Based upon quantitative susceptibility studies.
¶ See text for doses.
Δ Some clinicians may choose this alternative for convenience and cost savings.
◊ Addition of rifampin after 24 to 48 hours of therapy may be warranted if:
  1. Clinical condition worsens, or
  2. Gram stain or culture of repeat cerebrospinal fluid indicates failure to substantially reduce bacterial number, or
  3. Ceftriaxone or cefotaxime minimum inhibitory concentration of 4 mcg/mL or greater
From: American Academy of Pediatrics. Pneumococcal infections. In: Red Book: 2012 Report of the Committee on Infectious Diseases, 29th ed, Pickering LK (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2012. Used with the permission of the American Academy of Pediatrics. Copyright © 2012. The contents of this table remain unchanged in the Red Book: 2018 Report of the Committee on Infectious Diseases, 31st ed.
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