Bacterial meningitis initial empiric antibiotics < 3 months = IV cefotaxime + am

Intravenous cefotaxime and amoxicillin are used as initial empiric antibiotics in infants under 3 months with suspected bacterial meningitis to provide broad-spectrum coverage against the most likely causative organisms.

Cefotaxime, a third-generation cephalosporin, is effective against common pathogens such as Neisseria meningitidis, Streptococcus pneumoniae, Haemophilus influenzae, and Gram-negative bacilli, which are frequent causes of bacterial meningitis in this age group.

Amoxicillin is added specifically to cover Listeria monocytogenes, a pathogen particularly relevant in neonates and young infants, which is not reliably covered by cephalosporins alone.

This combination ensures empiric treatment covers both typical and atypical organisms until microbiological results are available to guide targeted therapy.

Additionally, cefotaxime is preferred over ceftriaxone in neonates under 41 weeks corrected gestational age due to safety concerns with ceftriaxone in this population.

Therefore, the rationale is to provide effective, safe, and comprehensive initial antimicrobial coverage for the diverse bacterial pathogens causing meningitis in infants under 3 months.

References: NICE NG240, NICE NG195, Products