Infectious Diseases II

Agent

CSF Penetration,

% of Serum Concentration

Dosage for Meningitis

Amikacin

Low

Conventional: 10–15 mg/kga IV q8–12hr

Extended interval: 20–25 mg/kga IV once daily

Intraventricular: 30 mg once daily

Ampicillin

13–14

2 g IV q4hr

Cefazolin

8–15

2 g IV q8hr

Cefepime

10–20

2 g IV q8hr

Cefotaxime

10–12

2 g IV q4hr

Ceftazidime

30–40

2 g IV q8hr

Ceftriaxone

8–12

2 g IV q12hr

Ciprofloxacin

20–25

400 mg IV q8hr

Colistin

Low

Intraventricular: 10 mg once daily

Meropenem

6–21

2 g IV q8hr (extended infusions over 3 hr may be

considered)

Nafcillin

1–2.5

2 g IV q4hr

Piperacillin/tazobactam

20–30

Not recommended because of low penetration of

tazobactam

Tobramycin

10–20

Conventional 2–3 mg/kg IV q8–12hr

Extended interval: 5–7 mg/kg IV once daily

Intraventricular 10–20 mg once daily

Vancomycin

15–20 mg/kg IV q8–12hr

Intraventricular 10–20 mg once daily

a Use IBW unless actual body weight is > 20% of IBW. If actual body weight is >20% IBW use adjusted body weight. Adjusted body weight = IBW + 0.4 (actual

weight − IBW).

IV = intravenous(ly); q = every

Patient Case

mental status changes, lethargy, and a temperature of 102.9°F (39.4°C). Her husband reports that she had

a severe headache 24 hours earlier. She has no significant medical history. Diagnostic workup results are

highly suggestive of meningitis. A lumbar puncture is performed, during which a high initial pressure is

noted. Which intervention would be best initially for H.K.?