Empiric antibiotic therapy is started for suspected community-acquired acute bacterial meningitis in a 62-year-old woman with no immunocompromise, no recent surgery, and no otitis. Which regimen is most appropriate before culture results return?
- A Ceftriaxone plus metronidazole
- B Ceftriaxone plus vancomycin plus ampicillin ✓
- C Benzylpenicillin alone
- D Meropenem plus amikacin
Correct answer: B. Ceftriaxone plus vancomycin plus ampicillin
Explanation
In adults over 50 years, Listeria monocytogenes becomes a relevant pathogen alongside pneumococcus and meningococcus, so empiric therapy adds ampicillin to the standard ceftriaxone (or cefotaxime) plus vancomycin combination covering penicillin-resistant pneumococci. Ceftriaxone plus metronidazole targets anaerobes in post-otitic or post-neurosurgical meningitis, penicillin alone fails against resistant pneumococcus and Listeria, and meropenem with amikacin is reserved for resistant gram-negative or post-procedural settings.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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