Posttraumatic meningitis treatment

see also Cerebrospinal fluid fistula treatment.

1. antibiotics: appropriate antibiotics are selected based on CSF penetration and organism sensitivities (adapted to the pathogens common in the patient’s locale). For empiric antibiotics: Vancomycin 15 mg/kg IV q 8–12 hours to achieve trough 15–20 mg/dl + meropenem 2 g IV q 8 hrs

3. pneumococcal vaccine: for adults (age ≥ 19 years) with Cerebrospinal fluid fistula who have not received any pneumococcal vaccines, or for those with unknown vaccination history, the CDC recommends 1 dose of PCV13 and 1 or 2 doses of PPSV23 as follows ¹⁾ (Note: these recommendations are specific for adults with Cerebrospinal fluid fistulas and differ from general vaccination recommendations):

● 1 dose of pneumococcal conjugate vaccine (pneumococcal PCV13) (e.g. Prevnar 13)

● 1 dose of pneumococcal polysaccharide vaccine (PPSV23) (e.g. Pneumovax, Merck) at least 8 weeks later

● for patients ≥ 65 years: PPSV23 ≥ 8 weeks after PCV13 and ≥ 5 years after any PPSV23 at < 65 years

4. surgical treatment vs. “conservative treatment”: controversial. Some feel that any case of post-traumatic CSF rhinorrhea should be explored, and that cases of spontaneous cessation often represent obscuration by the incarcerated brain, so-called “sham healing” with the potential for later CSF leak and/or meningitis.

4 Others support the notion that cessation (possibly with the assistance of lumbar spinal drainage) is acceptable

5. continue antibiotics for 1 week after CSF is sterilized. If rhinorrhea persists at this time, surgical repair is recommended