Meningitis <1 Mnth of Age

Question 1

Initial Empiric Therapy (<1 month, meningitis)
Q: What is the empiric antibiotic combo for a neonate with suspected meningitis and negative Gram stain?

Answer 1

A: Ampicillin + Gentamicin + Cefotaxime
🧠 Tip: Covers GBS, E. coli, and Listeria broadly.

Question 2

GBS Suspected (Gram+ cocci in chains)
Q: What if Gram stain shows Gram-positive cocci (likely GBS)?

Answer 2

A: Use Ampicillin ± Gentamicin
🧠 Tip: Ampicillin covers GBS well; cefotaxime not needed here.

Question 3

Pneumococcus Suspected (Gram+ diplococci)
Q: What if Gram stain shows Gram-positive diplococci (likely pneumococcus)?

Answer 3

A: Use Cefotaxime + Vancomycin
🧠 Tip: Vancomycin added in case of penicillin resistance.

Question 4

E. coli Suspected (Gram– rods)
Q: What if Gram stain shows Gram-negative rods (e.g., E. coli)?

Answer 4

A: Use Cefotaxime ± Gentamicin
🧠 Tip: Good Gram-negative coverage; gent for synergy.

Question 5

Listeria Coverage
Q: What antibiotic combo covers Listeria monocytogenes in neonates?

Answer 5

A: Ampicillin + Gentamicin
🧠 Tip: Always think of Listeria in neonates and maternal infection.

Question 6

Why not Ceftriaxone in neonates?
Q: Why is ceftriaxone avoided in neonates?

Answer 6

Risk of bilirubin displacement → kernicterus
🧠 Tip: Stick with cefotaxime instead.