Version July 2025
| Standard regimen¶ | Cephalosporin allergy or intoleranceΔ | |
| Adults | Vancomycin: Administer an initial loading dose (25 to 30 mg/kg, rounded to the nearest 250 mg increment) then give 15 to 20 mg/kg IV every 8 to 12 hours (maximum 2 g per dose or a total daily dose of 60 mg/kg initially)◊ plus either: Ceftriaxone: 2 g IV every 12 hours or Cefotaxime: 2 g IV every 4 to 6 hours | Vancomycin: Administer an initial loading dose (25 to 30 mg/kg, rounded to the nearest 250 mg increment) then give 15 to 20 mg/kg IV every 8 to 12 hours (maximum 2 g per dose or a total daily dose of 60 mg/kg initially)◊ plus either: Moxifloxacin: 400 mg IV every 24 hours§ or Meropenem: 2 g IV every 8 hours§ |
| Children | Vancomycin: 15 mg/kg IV every 6 hours (maximum 2 g per dose, initially) plus either: Ceftriaxone: 50 mg/kg IV every 12 hours (maximum 2 g per dose) or Cefotaxime: 75 mg/kg IV every 6 hours or 50 mg/kg IV every 4 hours (maximum 2 g per dose and 12 g per day) | Vancomycin: 15 mg/kg per IV every 6 hours (maximum 2 g per dose, initially) plus either: Levofloxacin§: ≥6 months old and <50 kg: 10 mg/kg IV every 12 hours (maximum 375 mg per dose) ≥50 kg: 750 mg IV every 24 hours (maximum 750 mg per day) or Meropenem: 40 mg/kg IV every 8 hours (maximum 2 g per dose)§ |
IV: intravenously.
* Modifications to these regimens may be needed based on suspected source of infection, exposure history, risk for multidrug-resistant pathogens, renal dysfunction, and other patient-specific factors.
¶ For most adults with suspected bacterial meningitis, we give adjunctive dexamethasone. The decision to use adjunctive dexamethasone in children is individualized. For selected patients, we also give adjunctive intravenous immunoglobulin.
Δ Following the first dose of antibiotics, we generally consult an allergist to determine whether the patient can be transitioned to a cephalosporin.
◊ The vancomycin dose should be adjusted to achieve a trough concentration of 15 to 20 mcg/mL for adults.
§ Meropenem is an alternative to fluoroquinolones for adults and children who have a history of mild, delayed reactions to cephalosporins or immunoglobulin E-mediated reactions to penicillin or cephalosporins. Meropenem is preferred by some experts, particularly for patients with meningitis and/or severe sepsis, because the likelihood of cross-reactivity is low.