Meningitis dosage

Penicillin is the dmg of choice for the treatment of group B streptococcal, meningococcal and pneumococcal infections but, as discussed earlier, CSF concentrations of penicillin are significantly influenced by the intensity of the inflammatoiy response. To achieve therapeutic concentrations within the CSF, high dosages are required, and in the case of pneumococcal meningitis should be continued for 10-14 days. 

The use of intrathecal amphotericin B is not recommended for the treatment of cryptococcal meningitis except in very ill patients or in those with recurrent or progressive disease despite aggressive IV amphotericin B therapy. The dosage of amphotericin B employed is usually 0.5 mg administered via the lumbar, cisternal, or intraventricular (via an Ommaya reservoir) route two or three times weekly. 

Adults 50 mg/kg/day in divided doses every 6 hours for typhoid fever and rickettsial infections. Exceptional infections (ie, meningitis, brain abscess) caused by moderately resistant organisms may require dosage up to 100 mg/kg/day to achieve... 

Cryptococcal meningitis 400 mg on the first day, followed by 200 mg once daily. A dosage of 400 mg once daily may be used, based on the patient s response to therapy. The duration of treatment for initial therapy of cryptococcal meningitis is 10 to 12 weeks after the cerebrospinal fluid becomes culture negative. The dosage of fluconazole for suppression of relapse of cryptococcal meningitis in patients with AIDS is 200 mg once daily. 

Meningitis, serious gynecologic and intra-abdominal infections IV, IM 2g q 12h. Dosage in renal impairment After an initial I -g dose, dosage and frequency are modified based on creatinine clearance and the severity of f he infection. 

Indications and Dosages Intra-ahdominal infections IV Meningitis IV 2gq8h. 

I Indications and Dosages Penicillins maybe used to treat a large number of infections, including pneumonia and other respiratory diseases, urinary tract infections, septicemia, meningitis, intra-abdominal infections, gonorrhea, syphilis, and bone and joint infections. 

Because of potential toxicity, bacterial resistance, and the availability of many other effective alternatives, chloramphenicol is rarely used. It may be considered for treatment of serious rickettsial infections such as typhus and Rocky Mountain spotted fever. It is an alternative to a B-lactam antibiotic for treatment of meningococcal meningitis occurring in patients who have major hypersensitivity reactions to penicillin or bacterial meningitis caused by penicillin-resistant strains of pneumococci. The dosage is 50-100 mg/kg/d in four divided doses. 

To decrease dose-related toxicity by using reduced doses of one or more components of the drug regimen. The use of flucytosine in combination with amphotericin for the treatment of cryptococcal meningitis in non-HIV-infected patients allows for a reduction in amphotericin dosage with decreased amphotericin -induced nephrotoxicity. 

Dosage Oropharyngeal Candidiasis 200 mg on first day, followed by 100 mg/d for at least 2 weeks Esophageal Candidiasis 200 mg on first day, followed by 100 mg/d for a minimum of 3 weeks and for at least 2 weeks after resolution of symptoms Systemic Candidiasis Up to 400 mg/d Cryptococcal Meningitis 400 mg on first day, followed by 200 mg/d for 10 to 12 weeks after cerebrospinal fluid becomes culture negative Dosage Adjustments lor Renal Impairment CrCl (mL/min) % of Recommended Dose >50 100% 11-50 50% Patients on hemodialysis One recommended dose after each dialysis ... 

It then undergoes enterohepatic recirculation, with the bulk excreted as a deacylated metabolite in feces and a small amount in the urine. Dosage adjustment for renal insufficiency is not necessary. Usual doses result in serum levels of 5-7 g/mL. Rifampin is distributed widely in body fluids and tissues. Rifampin is relatively highly protein-bound, but adequate cerebrospinal fluid concentrations are achieved only in the presence of meningeal inflammation. 

Rifampin is used in a variety of other clinical situations. An oral dosage of 600 mg twice daily for 2 days can eliminate meningococcal carriage. Rifampin, 20 mg/kg/d for 4 days, is used as prophylaxis in contacts of children with Haemophilus influenzae type b disease. Rifampin combined with a second agent is used to eradicate staphylococcal carriage. Rifampin combination therapy is also indicated for treatment of serious staphylococcal infections such as osteomyelitis and prosthetic valve endocarditis. Rifampin has been recommended also for use in combination with ceftriaxone or vancomycin in treatment of meningitis caused by highly penicillin-resistant strains of pneumococci. 

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