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Table 7 Empirical treatment recommendations for suspected bacterial meningitis

From: A systematic review of clinical guidelines on the management of acute, community-acquired CNS infections

Initial treatment recommendations*
 CMG 3rd-generation cephalosporin (ceftriaxone^ or cefotaxime) 3rd generation-cephalosporin (ceftriaxone^ or cefotaxime) plus a penicillin (amoxicillin, ampicillin or penicillin) Aminoglycoside (gentamicin) plus a penicillin (amoxicillin or ampicillin) Add: glycopeptide (vancomycin) Add: corticosteroids (before or with first dose of antibiotics)
 EFNS Europe P, A E   Older children and adults** Yes
 ESCMID Europe P, A N, A > 50 years, or if risk factor for L. monocytogenes N **,^ Yes^ up to 4 h post-antibiotics
 DSI Denmark A A if risk of L. monocytogenes    Yes
 SPILF France P, A P, A if suspected L. monocytogenes°   If S. pneumoniae Yes
 DGN: BM Germany A A   A** Yes
 HPSC Ireland P > 2 m, A N, P < 2 months N, P < 2 months **,^ Yes up to 24 h post-antibiotics
 NVN Netherlands P, A N, A    Yes
 MHSSE# Spain P     Yes
 NICE UK P > 3 m N, P < 3 months   If travel outside of the UK Yes^^ up to 12 h post-antibiotics
 UKJSS UK A A > 60 years   Pending travel history Yes up to 12 h post-antibiotics
 SIGN# Scotland P > 3 m N, P ≤ 3 months    Yes up to 24 h post-antibiotics
 IDSA USA/Global P, A N, A > 50 years N P, A P^, infants if Hib, A
 AEPED Spain P N, P ≤ 3 months   **,^ Yes
 MSF Global P > 3 m, A N, P ≤ 3 months N, P ≤ 3 months   Yes^
 NNF Norway NS NS    Yes
  1. The table shows empirical treatment recommendations for different risk groups
  2. *Initial recommendations to be reviewed as appropriate pending diagnostic results
  3. **If suspicion of reduced sensitivity to penicillin
  4. ^Not to neonates
  5. ^^Not to infants < 3 months
  6. Not to immunosuppressed
  7. #Focused on N. meningitidis only
  8. Abbreviations: N neonate, P paediatric populations, A adults, E elderly, NS non-specified population, EFNS European Federation of Neurological Societies, ESCMID European Society of Clinical Microbiology and Infectious Diseases, DSI Dansk Selskab for Infektionsmedicin, SPILF Société de Pathologie Infectieuse de Langue Française, DGN Deutsche Gesellschaft für Neurologie, BM Bakterielle Meningoenzephalitis, HPSC Health Protection Surveillance Centre, NVN Nederlandse Vereniging voor Neurologie, MHSSE Ministry of Health, Social Services and Equality, NICE The National Institute for Health and Care Excellence, UKJSS UK Joint Specialist Societies, SIGN Scottish Intercollegiate Guidelines Network, IDSA Infectious Diseases Society of America, AEPED Asociación Española de Pediatría, MSF Médecins Sans Frontières, NNF Norsk Nevrologisk Forening