CENTRAL NERVOUS SYSTEM INFECTIONS

Infection/Condition and Likely Organism

Suggested Treatment

Comments

Preferred

Alternative

Age groups:

1-3 months:

Group B streptococcus (GBS), Escherichia coli,  Streptococcus pneumoniae and Neisseria meningitidis

>3 months:

Streptococcus penumoniae, Haemophilus influenzae type b, Escherichia coli, Salmonella and Neisseria meningitidis

Cefotaxime 200-300mg/ kg/day IV in 4 divided doses (max. 2gm/dose)

OR

Ceftriaxone 100mg/kg/ day IV in 1-2 divided doses (max. 2gm/dose; 4gm/ day)

PLUS

Vancomycin 60mg/kg/ day IV in 2-3 divided doses (max. 2gm/day)

For children below 3 months of age: Cefotaxime is the preferred third generation cephalosporin since less drug-drug interactions (in terms of interaction with calcium-containing infusion and bilirubin displacement).

Once organism is known, please refer below to adjust antibiotics.

Infection/Condition and Likely Organism

Suggested Treatment

Comments

Preferred

Alternative

Haemophilus influenzae

Ampicillin 300mg/kg/day q6h (if MIC <1mcg/ml)

Cefotaxime 200-300mg/ kg/day IV in 4 divided doses (max. 2gm/dose)

OR

Ceftriaxone 100mg/kg/ day IV in 1-2 divided doses (max. 2gm/dose; 4gm/ day)

Duration: 10 days.

Neisseria meningitidis

Benzylpenicillin 300,000- 400,000 units/kg/day; (max. 12 MU/day) IV in 4-6 divided doses for 7 days

Cefotaxime 200-300mg/ kg/day IV in 4 divided doses (max. 2gm/dose) for 7 days

OR

Ceftriaxone 100mg/kg/ day IV in 1-2 divided doses (max. 2gm/dose; 4gm/ day) for 7 days

Prophylaxis for all household contacts and health care workers involved in unprotected contact during intubation and suctioning of airway/mouth-to-mouth resuscitation.

Streptococcus pneumoniae

Penicillin-susceptible (MIC≤0.06 mcg/ml)

Benzylpenicillin 300,00-400,000 units/kg/day in 4-6 divided doses (max. 24MU/day)

Duration: 14 days.

Penicillin-resistant

(MIC≥0.12 mcg/ml) and Cefotaxime/ Ceftriaxone- susceptible (MIC ≤0.5 mcg/ ml)

Cefotaxime 200-300mg/ kg/day IV in 4 divided doses (max. 2gm/dose)

OR

Ceftriaxone 100mg/kg/ day IV in 1-2 divided doses (max. 2gm/dose; 4gm/ day)

Penicillin and Cefotaxime/ Ceftriaxone resistant (MIC ≥2.0 mcg/ml) (drug-resistant Streptococcus pneumoniae, DRSP)

Cefotaxime 300mg/kg/day

OR

Ceftriaxone 100mg/kg/ day PLUS

Vancomycin 60mg/kg/day in 4 divided doses

Cryptococcal meningitis Cryptococcus neoformans

Induction therapy: Amphotericin B 1.0mg/kg/day IV q24h

PLUS*

5-flucytosine 25mg/kg/ dose (max. 2gm/dose) PO q6h for 2-4 weeks

Duration of induction with 5-flucytosine (5-FU) is at least 2 weeks and until CSF repeat culture is NEGATIVE.

Consolidation Therapy:

Fluconazole 6mg/kg/dose (max. 400mg/dose) IV/PO q12h for 8 weeks

Herpes simplex encephalitis

4 months to 12 years old: Acyclovir 30-45mg/kg/day slow IV infusion in 3 divided doses

Duration: 14-21 days.

Doses of 60mg/kg/day OR dosing exceeding 15mg/kg or 500mg/m² is associated with acute kidney injury.

Infection/Condition and Likely Organism

Suggested Treatment

Comments

Preferred

Alternative

Brain abscess

(Flu)Cloxacillin 200mg/kg/day IV in 4-6 divided doses

PLUS

Cefotaxime 200-300mg/ kg/day IV in 4 divided doses (max. 2gm/dose)

OR

Ceftriaxone 100mg/kg/ day IV in 1-2 divided doses (max. 2gm/dose; 4 gm/ day)

PLUS

Metronidazole 15mg/kg IV stat then 7.5mg/kg IV q8h

If secondary to head trauma or post-neurosurgical procedure:

Vancomycin 60mg/kg/day IV in 2-3 divided doses (max. 2gm/day)

PLUS

Cefotaxime 200-300mg/ kg/day IV in 4 divided doses (max. 2gm/dose)

OR

Ceftriaxone 100mg/kg/ day IV in 1-2 divided doses (max. 2gm/dose; 4 gm/ day)

Surgical drainage may be indicated if appropriate.

Duration: 6-8 weeks, depending on response based on neuroimaging and clinical presentations.