For the empiric treatment of meningitis in patients of all ages, which antibiotics are indicated?

The empiric treatment of meningitis in patients of all ages typically involves the use of vancomycin and ceftriaxone. This combination is effective against the most common pathogens responsible for bacterial meningitis, including Streptococcus pneumoniae and Neisseria meningitidis, which are prevalent in both children and adults.

Ceftriaxone is a broad-spectrum cephalosporin that provides coverage against Gram-negative bacteria, including those that can cause meningitis, while also offering good activity against Streptococcus pneumoniae. Vancomycin is added to cover for resistant strains of these bacteria, particularly penicillin-resistant Streptococcus pneumoniae, which can cause severe morbidity in this patient population. This dual-therapy approach ensures adequate coverage for the most likely organisms while awaiting culture results.

Other combinations might not provide comprehensive coverage for the potential pathogens involved in meningitis. Therefore, the combination of vancomycin and ceftriaxone is recommended as the preferred empiric treatment for meningitis in patients of all ages.