Case-Based Modules > Case 4 > Stage 6

Sorry! While their input will be helpful in the short-term, you need an answer now. It's important to know the empiric antimicrobials with which to start; after that, sure, ID can help guide things.

For standard bacterial meningitis, you'll need vancomycin and ceftriaxone (you'll mainly care about covering for S. pneumoniae, N. meningitidis, H. influenzae). Side note: the vancomycin is actually to double-cover the S. pneumoniae, not MRSA, as S. pneumoniae resistance to ceftriaxone developed in the 1990s. However, vancomycin resistance may also be brewing. For standard viral meningitis, you'll need to add acyclovir for HSV coverage. For patients age 50 and older, you'll need to add ampicillin to cover for Listeria. For cryptococcal meningitis, you'll want to start with liposomal amphotericin B and flucytosine.

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