Post-neurosurgical procedure meningitis

usual organisms: coagulase-negative staphylococci, S. aureus, Enterobacteriaceae, Pseudomonas sp., pneumococci (usually with basilar skull fractures and otorhinologic surgery)

2. Empiric antimicrobial therapy: - vancomycin (to cover MRSA), adult ℞ 15 mg/kg q 8–12 hrs to achieve trough 15–20 mg/dl + cefepime 2 g IV q 8 hrs

3. if severe PCN allergy, use aztreonam 2 g IV q 6–8 hrs or ciprofloxacin 400 mg IV q 8 hrs

4. if severe infection, consider intrathecal therapy delivered daily (use only preservative-free drug)

● vancomycin

● tobramycin/gentamicin

● amikacin

● colistin

5. streamline ABX based on sensitivities, e.g. if organism turns out to be MSSA, change vancomycin, oxacillin, or nafcillin