Common organisms
- • S. pneumoniae
- • N. meningitidis
- • H. influenzae
- • Listeria (>50y / immunocompromised)
Empirical therapy
- • Ceftriaxone 2 g IV BD + Vancomycin
- • Add Ampicillin 2 g IV q4h if >50y or immunocompromised
- • Dexamethasone 10 mg IV q6h x 4d (give with/before first antibiotic dose)
Culture-directed
- • Per CSF culture and PCR
Adverse effects
- • Steroid hyperglycaemia, GI bleed
- • Vanco infusion reaction
Monitoring
- • GCS, focal signs
- • Repeat LP only if not improving
Clinical pearls
- • Do not delay antibiotics for CT/LP
- • Notify public health
Educational support only — follow local antibiogram and institutional protocols.
