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18-50 years old and immunocompetent

Usual Pathogens

S. pneumoniae
N. meningitidis
H. influenzae

Empiric Therapy	Dose	Duration
Dexamethasone	10mg IV q6h	If S. pneumoniae or H. influenzae, or no pathogen identified - 4 days. If neither S. pneumoniae nor H. influenzae, discontinue dexamethasone. If Listeria, discontinue dexamethasone immediately as associated with increased mortality.
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Ceftriaxone	2g IV q12h	See Duration
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Vancomycin	15mg/kg IV q8-12h

Ceftriaxone allergy

Empiric Therapy	Dose	Duration
Dexamethasone	10mg IV q6h	If S. pneumoniae or H. influenzae, or no pathogen identified - 4 days. If neither S. pneumoniae nor H. influenzae, discontinue dexamethasone. If Listeria, discontinue dexamethasone immediately as associated with increased mortality.
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Meropenem	2g IV q8h	See Duration
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Vancomycin	15mg/kg IV q8-12h

Carbapenem allergy

Empiric Therapy	Dose	Duration
Dexamethasone	10mg IV q6h	If S. pneumoniae or H. influenzae, or no pathogen identified - 4 days. If neither S. pneumoniae nor H. influenzae, discontinue dexamethasone. If Listeria, discontinue dexamethasone immediately as associated with increased mortality.
+
[TMP/SMX	15-20mg TMP/kg/day IV div q6-8h	See Duration
or
Moxifloxacin]	400mg IV daily
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Vancomycin	15mg/kg IV q8-12h