Post-neurosurgical procedure meningitis [Neurosurgery Wiki]

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====== Post-neurosurgical procedure meningitis ======

usual organisms: [[coagulase-negative staphylococci]], S. aureus, [[Enterobacteriaceae]], Pseudomonas sp., pneumococci (usually with [[basilar skull fracture]]s and otorhinologic surgery)

2. [[Empiric antimicrobial therapy]]:   - [[vancomycin]] (to cover [[MRSA]]), adult ℞ 15 mg/kg q 8–12 hrs to achieve trough 15–20 mg/dl + cefepime 2 g IV q 8 hrs

3. if severe PCN allergy, use aztreonam 2 g IV q 6–8 hrs or ciprofloxacin 400 mg IV q 8 hrs

4. if severe infection, consider intrathecal therapy delivered daily (use only preservative-free drug)

● [[vancomycin]]

● tobramycin/gentamicin 

● amikacin

● colistin

5. streamline ABX based on sensitivities, e.g. if organism turns out to be MSSA, change vancomycin, oxacillin, or nafcillin