A child who previously was healthy develops bacterial meningitis. Assuming no specific contraindications, which of the following is the drug of choice?
Correct Answer: Ceftriaxone
Description: Penicillins were used in the treatment of meningitis because of their ability to pass across an inflamed blood-brain barrier. The third generation cephalosporin, ceftriaxone, is preferred because it is effective against b-lactamase producing strains of H. influenzae that may cause meningitis in children.Because of the efficacy of third-generation cephalosporins in the therapy of meningitis caused by sensitive S. pneumoniae, N. meningitidis, and H. influenzae type b, cefotaxime (300 mg/kg/24 hr, given every 6 hr) or ceftriaxone (100 mg/kg/24 hr administered once per day or 50 mg/kg/dose, given every 12 hr) should also be used in initial empirical therapy. Patients allergic to b-lactam antibiotics and >1 mo of age can be treated with chloramphenicol, 100 mg/kg/24 hr, given every 6 hr. Another option for patients with allergy to b-lactam antibiotics is a combination of vancomycin and rifampin.Ref: Nelson Paediatrics; 20th edition; Chapter 603 * Central Nervous System Infections; Page no: 2941
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