7
➤ For treatment of patients with healthcare-associated ventriculitis
and meningitis caused by staphylococci in whom β-lactam agents
or vancomycin cannot be used, linezolid (S-L), daptomycin (S-L), or
trimethoprim-sulfamethoxazole (S-L) is recommended with selection
of a specific agent based on in vitro susceptibility testing.
➤ For treatment of infection caused by P. acnes, penicillin G is
recommended (S-M).
➤ For treatment of infection caused by gram-negative bacilli, therapy
should be based on in vitro susceptibility testing with agents that
achieve good CNS penetration (S-M).
➤ For treatment of infection caused by gram-negative bacilli susceptible
to third-generation cephalosporins, ceftriaxone or cefotaxime is
recommended (S-M).
➤ For treatment of infection caused by Pseudomonas species, the
recommended therapy is cefepime, ceftazidime or meropenem (S-M).
Recommended alternative antimicrobial agents are aztreonam or a
fluoroquinolone with in vitro activity (S-M).
➤ For treatment of infection caused by extended spectrum β-lactamase
(ESBL)-producing gram-negative bacilli, meropenem should be used
if this isolate demonstrates in vitro susceptibility (S-M).
➤ For treatment of infection caused by Acinetobacter species,
meropenem is recommended (S-M). For strains demonstrating
carbapenem resistance, colistimethate sodium or polymyxin B (either
agent administered by the intravenous and intraventricular routes) is
recommended (S-M).
➤ Prolonged infusion of meropenem (each dose administered over
3 hours) may be successful in treating resistant gram-negative
organisms (W-L).
➤ For treatment of infection caused by Candida species, based on in
vitro susceptibility testing, liposomal amphotericin B, often combined
with 5-flucytosine, is recommended (S-M). Once the patient shows
clinical improvement, therapy can be changed to fluconazole if the
isolated species is susceptible (W-L).
➤ For treatment of infection caused by Aspergillus or Exserophilum
species, voriconazole is recommended (S-L).
S, strong ; W, weak — strength of recommendation
H, high; M, moderate; L, low; VL, very low — quality of evidence
