[Presumptive bacterial meningitis in adults: initial antimicrobial therapy].
CSF sterilization should be obtained very rapidly to reduce both mortality and morbidity due to bacterial meningitis. Thus, antibiotic treatment should be adapted to the suspected bacterium and administered as early as possible at high dosage with - if necessary - a loading dose and continuous perfusion. The rates of abnormal susceptibility to penicillin of Streptococcus pneumoniae, Neisseria meningitis and Haemophilus influenzae are 37%, 30% and 12% respectively. Thus, ceftriaxone or cefotaxim must be used as empirical treatment. Listeria monocytogenes remains fully susceptible to aminopenicillin, so, the combination aminopenicillin and aminoglycoside is the first-line treatment. Antibiotic resistance, allergy or contra-indications, are in fact rare but in these cases, antibiotic combinations are often needed. The latter are more or less complex and clinically validated; they include molecules such as vancomycine, fosfomycin, fluoroquinolone or linezolid.
Département d'infectiologie, CHU de Dijon, BP 77908, 21000 Dijon, France. pascal.chavanet@chu-dijon.fr
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D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001812:Blood-Brain Barrier; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D004305:Dose-Response Relationship, Drug; D006192:Haemophilus Infections / Q000188:drug therapy; D006193:Haemophilus influenzae; D006801:Humans; D015378:Imipenem / Q000008:administration & dosage / Q000627:therapeutic use; D007263:Infusions, Parenteral; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000188:drug therapy*; D008585:Meningitis, Meningococcal / Q000188:drug therapy; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009345:Neisseria meningitidis; D010406:Penicillins / Q000627:therapeutic use*; D013290:Streptococcal Infections / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D010406:Penicillins; D015378:Imipenem