Meningitis - Acute, Bacterial Drug Summary

Last updated: 02 February 2026
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Aminoglycosides

Drug Dosage Remarks
Amikacin 15-20 mg/kg/day IV divided 8-12 hourly
Max dose: 1.5 g/day		 Adverse Reactions
  • Ototoxic effects (irreversible hearing loss, dizziness, vertigo); Renal effects (reversible nephrotoxicity; acute renal failure has been reported usually when other nephrotoxic drugs have also been administered); Neuromuscular effect (neuromuscular blockade resulting in respiratory depression and muscular paralysis)
Special Instructions
  • Use with caution in patients with conditions associated with muscle weakness (eg myasthenia gravis, Parkinson’s disease), patients with pre-existing renal dysfunction, vestibular or cochlear impairment
  • Ototoxicity and nephrotoxicity are most likely in patients who are geriatric, dehydrated, with renal impairment, receiving high doses or for long periods and receiving or have received other ototoxic/nephrotoxic drugs
    • Consider monitoring serum concentrations and/or peak serum concentrations/MIC ratio in patients at risk for ototoxicity or nephrotoxicity
Gentamicin 3-5 mg/kg/day IM/IV divided 8 hourly
Netilmicin 4-6 mg/kg/day IM/IV divided 8-12 hourly
Tobramycin 5-7 mg/kg/dose IM/IV 8-12 hourly

Antibacterial Combination

Drug Dosage Remarks
Co-trimoxazole
(Sulfamethoxazole
[SMZ] and
Trimethoprim
[TM])		 10-20 mg TM/kg/day IV divided 6-12 hourly Adverse Reactions
  • GI effects (nausea/vomiting, anorexia, diarrhea, rarely antibiotic-associated diarrhea/colitis, glossitis); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity effects (rash, Stevens-Johnson [SJS] syndrome); Urogenital effect (crystallization in the urine)
  • Rarely hematologic effects (more common if given for long periods or with high doses), renal and hepatic effects, aseptic meningitis has occurred
Special Instruction
  • Maintain adequate fluid intake
  • Contraindicated in patients allergic to sulfonamides
  • Use with extreme caution or not at all in patients with hematological disorders especially megaloblastic anemia due to folic acid deficiency
  • Use with caution in patients with renal impairment or severe hepatic dysfunction and with caution in patients with folate deficiency (may consider administration of Folinic acid)

Cephalosporins

Drug Dosage Remarks
Second Generation Adverse Reactions
  • Hypersensitivity effects (urticaria, pruritus, rash, anaphylaxis); GI effects (diarrhea, nausea/vomiting, increased LFTs); CNS effects (headache, dizziness; high doses associated w/ encephalopathy & convulsions); Local effects (phlebitis, pain, inflammation); Other effect (candidal infection)
  • Prolonged prothrombin time (PT), prolonged activated partial thromboplastin time (PTT) and/or hypoprothrombinemia (with or without bleeding) have been reported and occur most frequently with N-methylthiotetrazole side chain-containing cephalosporins
Special Instructions
  • May be taken with food to decrease gastric distress
  • Use with caution in patients with non-severe hypersensitivity reactions to cephalosporins, penicillins or other drugs and renal impairment
Cefuroxime 1.5 g IV 6 hourly or
3 g IV 8 hourly
Max dose: 9 g/day
Third Generation
Cefoperazone 6-16 g/day IV divided
6-12 hourly
Max dose: 16 g/day
Cefotaxime 2 g IV 4-6 hourly
Max dose: 12 g/day
Cefotiam 6 g/day in divided doses
Ceftazidime 2 g IV 8 hourly
Ceftizoxime 1-3 g IV 6-12 hourly
Max dose: 12 g/day
Ceftriaxone 2 g IV 12 hourly
Fourth Generation
Cefepime 2 g IV 8 hourly
Max dose: 6 g/day
Cephalosporin w/ Beta-lactamase
Inhibitor
Cefoperazone/
sulbactam		 8 g/day IM/IV divided
12 hourly

Chloramphenicols

Drug Dosage Remarks
Chloramphenicol 50-100 mg/kg/day PO/IV divided 6 hourly Adverse Reactions
  • Hematologic effects (reversible bone marrow depression, rarely severe irreversible aplastic anemia); Hypersensitivity effect (anaphylactoid reactions); CNS effects (optic atrophy or neuropathy paresthesias); GI effects (nausea/vomiting, diarrhea, stomatitis, glossitis, bitter taste)
  • Gray syndrome (abdominal distention, vomiting, ashen color, irregular respiration, circulatory collapse, death) has occurred in newborns given large doses and can occur in adults and older children given high doses
Special Instructions
  • Avoid in patients with pre-existing bone marrow depression or blood dyscrasias
  • Dosage must be adjusted for patients with hepatic or renal insufficiency
  • Due to narrow therapeutic/toxic ratio, monitor serum levels if possible, particularly in patients with hepatic or renal disease
Thiamphenicol 250-500 mg PO 6-8 hourly

Macrolide

Drug Dosage Remarks
Roxithromycin Meningococcal meningitis prophylaxis:
150 mg PO 12 hourly or
300 mg PO 24 hourly		 Adverse Reactions
  • GI upset, allergic reactions
Special Instructions
  • Should be taken on an empty stomach or take before meals
  • Use with caution in patients with hepatic insufficiency

Other Antibiotics

Drug Dosage Remarks
Glycopeptide
Vancomycin 500 mg IV 6 hourly or 1 g IV 12 hourly given at a rate of ≤10/min or over at least 60 minutes Adverse Reactions
  • “Red neck syndrome” which is usually related to rapid infusion: Flushing, erythema, rash over face and upper torso, sometimes hypotension and shock-like symptoms
  • Hypersensitivity effects (can range from mild to severe anaphylactoid reactions, SJS); Hematologic effects; Renal effects (nephrotoxicity may occur especially at high doses or in patients with predisposing factors); Ototoxic effects (reversible ototoxicity is more likely with high plasma concentrations or in renal impairment, tinnitus may precede hearing loss and can be used as a sign to discontinue treatment)
Special Instructions
  • Avoid in patients with a history of impaired hearing
  • Use with caution in patients with impaired renal function and the elderly
  • Monitoring of serum concentrations may be done to help avoid renal and ototoxicity, monitoring of CBC, renal and auditory function during treatment is suggested
Rifamycin
Rifampicin Meningococcal meningitis prophylaxis:
600 mg PO 12 hourly x 2 days		 Adverse Reactions
  • Hepatic effects (transient asymptomatic hyperbilirubinemia, clinical hepatitis); GI effects (nausea/vomiting, anorexia, abdominal pain, diarrhea); Other effects (flu-like syndrome, orange discoloration of bodily fluids); Dermatologic effects (pruritus with or without rash)
  • Rare but severe immunologic effects (thrombocytopenia, hemolytic anemia, acute renal failure, thrombotic thrombocytopenic purpura)
Special Instructions
  • Should be taken on an empty stomach or 1 hour before or 2 hours after meals
  • Advise patient that soft contact lenses and clothing may be permanently stained orange
  • Clinical and lab monitoring in patients with underlying liver disease should be increased
  • Rifampicin causes many drug interactions and this may necessitate regular measurements of serum concentrations of drugs taken concomitantly

Other Beta-Lactams

Drug Dosage Remarks
Carbapenem
Meropenem 2 g IV 8 hourly Adverse Reactions
  • GI effects (diarrhea, nausea/vomiting, antibiotic-associated diarrhea/colitis, tongue/tooth discoloration, altered taste); Hypersensitivity effects (rash, anaphylaxis); Other effect (candidal infections); CNS effects (mental disturbances, confusion; Imipenem/cilastatin: Seizures and convulsions have been reported especially in patients with a history of CNS lesions and/or renal dysfunction)
  • Rarely hepatic and severe dermatologic effects (eg exfoliative dermatitis)
Special Instructions
  • Use with caution in patients allergic to penicillins, cephalosporins or other beta-lactams, patients with renal impairment
  • Use with caution in patients with CNS disorders (eg epilepsy)
Monobactam
Aztreonam 1-8 g/day IM/IV divided
6-12 hourly
Max dose: 8 g/day		 Adverse Reactions
  • Hypersensitivity effects (rash, urticaria, pruritus, anaphylaxis); GI effects (diarrhea, nausea/vomiting, antibiotic-associated diarrhea/colitis); Other effect (candidal infections)
  • Rarely hematologic, renal and hepatic effects
Special Instructions
  • Use with caution in patients allergic to penicillins, cephalosporins or other beta-lactams and in patients with renal impairment

Penicillins

Drug Dosage Remarks
Benzylpenicillin
(Penicillin G, Penicillin G Na, Penicillin G)		 Pneumococcal/meningococcal
meningitis: 2.4 g IV 4 hourly		 Adverse Reactions
  • Hypersensitivity effects (rash, urticaria, pruritus, anaphylaxis); GI effects (diarrhea, nausea/vomiting); Other effect (candidal infections)
  • High doses may be associated with CNS effects (encephalopathy, convulsions)
Special Instructions
  • Avoid in patients with Penicillin allergy
  • Use with caution in patients with renal impairment
Aminopenicillin
Ampicillin 150-300 mg/kg/day IV divided 4-6 hourly or
2 g IV 4-6 hourly
Antistaphylococcal Penicillins
Cloxacillin 250-500 mg PO 6-8 hourly or
250-500 mg IM/IV 4-6 hourly
Flucloxacillin 500-2,000 mg IV 6 hourly
Oxacillin 6-12 g/day IV divided 4-6 hourly or
250-2,000 mg IM/IV 4-6 hourly
Max dose: 12 g/day
1 g IM/IV 4-6 hourly

Quinolones

Drug Dosage Remarks
Ciprofloxacin Meningococcal meningitis prophylaxis:
500 mg PO as single dose		 Adverse Reactions
  • GI effects (nausea/vomiting, diarrhea, abdominal pain, dyspepsia, diarrhea, rarely antibiotic-associated diarrhea/colitis); CNS effects (headache, dizziness, sleep disorders, restlessness, drowsiness); Dermatologic effects (rash, pruritus, photosensitivity); Hypersensitivity effects (rash, SJS)
  • Rarely hematologic, renal and hepatic effects
  • Some quinolones have the potential to prolong the QT interval
Special Instructions
  • Administer at least 2 hours before or 3 hours after Al- or Mg-containing antacids, dietary supplements containing Zn or Fe or buffered ddI preparations
  • Use with caution in patients with epilepsy or history of CNS disorders, in patients with impaired renal or hepatic function and in those with G6PD deficiency
  • Avoid exposure to strong sunlight or tanning beds
Moxifloxacin 400 mg IV 24 hourly

Vaccines

Drug Dosage1 Remarks
Haemophilus b vaccine2
(Haemophilus influenzae type b [Hib] vaccine)		 0.5 mL/dose IM Adverse Reactions
  • Injection site effects (pain, erythema, swelling and/or inflammation, induration, irritability); Other effects (fever, loss of appetite)
Special Instructions
  • Administer in anterolateral aspect of thigh or deltoid muscle of upper arm
    • Administer SC in patients with thrombocytopenia or bleeding disorder
  • Contraindicated in patients with hypersensitivity to any vaccine component
  • Use with caution in immunodeficient patients or in patients on immunosuppressive treatment
  • Defer vaccination for patients with acute severe febrile illness
Meningococcal vaccine
(Meningococcal polysaccharide serogroups A, C, W-135 and Y conjugate)		 0.5 mL IM as single dose Adverse Reactions
  • Local effects (injection site soreness, erythema, swelling); Other effects (fever, headache)
Special Instructions
  • Unconjugated N meningitidis serogroup ACWY vaccine is administered SC
  • Contraindicated in patients with fever, acute disease, anaphylactic reaction to a previous dose or allergy to any component of the vaccine
  • Use with caution in patients with impaired immune response
Meningococcal vaccine
(Meningococcal serogroup B vaccine)		 0.5 mL IM for 2 doses at least 1 or 6 months apart or
3 doses with the first 2 doses at least 1 month apart followed by a third dose at least 4 months after the second dose
Pneumococcal vaccine
(Pneumococcal polysaccharide conjugate vaccine, 10-valent [PCV10])		 0.5 mL/dose IM Adverse Reactions
  • Injection site reactions, irritability, fever, loss of appetite
Special Instructions
  • Administer in anterolateral aspect of thigh or deltoid muscle of upper arm
    • Administer SC in patients with thrombocytopenia or bleeding disorder
  • Contraindicated in patients with hypersensitivity to any vaccine component
  • Use with caution in immunodeficient patients or in patients on immunosuppressive treatment
  • Defer vaccination for patients with acute severe febrile illness
Vaccine, pneumococcal
(Pneumococcal polysaccharide conjugate vaccine, 15-valent [PCV15])		 0.5 mL IM as single dose Adverse Reactions
  • Local effects (injection site erythema, swelling, pain); Other effects (headache, fatigue, myalgia, arthralgia)
Special Instructions
  • Contraindicated in patients with fever, acute disease, anaphylactic reaction to a previous dose or allergy to any component of the vaccine
  • Use with caution in patients with coagulation disorders or on anticoagulation therapy
Vaccine, pneumococcal
(Pneumococcal 20-valent conjugate vaccine [PCV20])		 0.5 mL IM as single dose Adverse Reactions
  • Local effects (injection site pain, swelling); Musculoskeletal effects (muscle pain, arthralgia); Other effects (fatigue, headache)
Special Instructions
  • Contraindicated in patients with anaphylactic reaction to a previous dose or allergy to any component of the vaccine or diphtheria toxoid
  • Use with caution in patients with altered immunocompetence
Pneumococcal vaccine
(Pneumococcal polysaccharide vaccine, 23-valent [PCV23])		 0.5 mL IM/SC as single dose
if unvaccinated or
vaccination history is
unknown		 Adverse Reactions
  • Local effects (injection site reactions, warmth, erythema, swelling); CNS effects (fever, headache, malaise)
Special Instructions
  • Re-vaccinate ≥5 years after first dose to people ≥65 years old if the first dose was given prior to 65 years of age or if at risk of fatal pneumococcal infection
  • Contraindicated in patients with fever, acute disease, anaphylactic reaction to a previous dose, severe primary immunodeficiency
  • Use with caution in patients with severe renal, hepatic, cardiac, vascular and/or pulmonary dysfunction
  • Efficacy may be reduced in patients with multiple myeloma, Hodgkin’s and non-Hodgkin’s lymphoma, especially during treatment
    • Should be given 2 weeks before or at least 3 months after immunosuppressive treatment
1Please refer to local guidelines for recommended immunization schedule.
2Combination with other vaccines are available. Please see the latest MIMS for specific formulations and prescribing information.

Disclaimer

All dosage recommendations are for non-pregnant and non-breastfeeding women, and non-elderly adults with normal renal and hepatic function unless otherwise stated.  
Not all products are available or approved for above use in all countries.  
Products listed in the Drug Summary are based on indications stated in the locally approved product monographs.   
Please refer to local product monographs in Related MIMS Drugs for country-specific prescribing information.  

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