Central nervous system infections
Central nervous system infections
| Clinical condition | Common pathogens | Empirical antimicrobial agents | Alternative antimicrobial agents | Comments |
|---|---|---|---|---|
| Acute bacterial meningitis | S. pneumoniae, Listeria monocytogenes, Haemophilus influenzae, Neisseria meningitidis | Ceftriaxone or cefotaxime plus ampicillin (for listeria) Plus vancomycin |
Moxifloxacin or meropenem |
Exclude TB, Cryptococcus
If penicillin allergic, use cotrimoxazole (TMP component) or meropenem to cover for Listeria Duration: 10-14 days, 21 days for Listeria or gram-negative infections |
| Brain abscess, subdural empyema | Streptococci, Bacteroides spp, Enterobacteriaceae, S. aureus, TB, Nocardia, Aspergillus | Ceftriaxone or cefotaxime plus Metronidazole Duration based on clinical and radiological response, minimum 8 weeks |
Meropenem | Aspiration / surgical drainage required unless abscess <2.5cm and patient neurologically stable |
| Nocardia spp | Co-trimoxazole (TMP component) IV/PO plus imipenem/ceftriaxone | Linezolid | Duration: 3-6 weeks of IV therapy followed by 12 months PO |