empirical therapy

Last reviewed 06/2021

Initial empirical therapy includes(1):

• urgent transfer to hospital
• in general practice, if bacterial meningitis is suspected a single STAT dose of benzylpenicillin should be given before urgent transfer to the hospital
• dexamethasone may be indicated as an adjunct in adults, before or when antibiotics are started.

Altrenative therapies that may be used as empirical therapy based on the likely agent for the age of the patient are:

• infants younger than three months:
  • cefotaxime, and ampicillin because of the possibility of Listeria meninigitis
• children:
  • ceftriaxone or cefotaxime
  • second line is chloramphenicol and ampicillin
• adults:
  • ceftriaxone or cefotaxime
  • second line therapies: benzylpenicillin or ampicillin
• older adults:
  • cefotaxime or ceftriaxone and ampicillin

Note: STAT indicates that intervension is emergent

Reference:

• (1) Meningitis: initial ‘blind’ therapy. British National Formulary. September 2007: p277