**9. Management**

In the meningitides with the onset in the first 3–6 days of life, the empirical therapy should be ampicillin + cefotaxime, ampicillin + gentamicin, or, if there is a very high probability that the causative organism is Gram negative, as in the case of detection of Gram-negative bacilli on smear, it should be ampicillin + gentamicin + cefotaxime [10].

After the first 3–6 days of life, ampicillin + gentamicin + cefotaxime for infants from outside of a healthcare facility, and vancomycin + gentamicin + cefotaxime for previously or currently hospitalized newborns would be appropriate choices [1, 10]. If *L. monocytogenes* grows in CSF or is suspected as the pathogen from the Gram smear, it is advisable to add ampicillin to vancomycin + gentamicin combination, because CSF concentrations of vancomycin are not bactericidal for Listeria [10].

Dosages of recommended drugs are depicted in **Table 3**.

Dexamethasone therapy, which is used for older children, is not recommended for neonatal meningitis [1, 10].

Acyclovir (20 mg/kg/dose, every 8 h, for 14–21 days) should be administered to all neonates with HSV disease, regardless of manifestations and clinical findings [21].

For newborns whose CSF shows growth of a pathogen, the duration of therapy should be 14 days for Gram-positive organisms and 21 days for Gram negatives if neither any complication nor resistance to therapy is present. If a growth is detected in blood culture but not in CSF, while CSF shows signs of inflammation, a therapy duration of 10 days for Gram-positive organisms and 14 days for Gram negatives would suffice. Empirical antimicrobial therapy


"neonate meningitis Turkish" revealed only two recent, relatively large-scale studies on the epidemiology of neonatal meningitis in Turkey, which points to the need for more local data

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The author contributed as the only person to this chapter with conception and design of the manuscript, literature review and analysis, drafting and critical revision and editing, and final

Division of Pediatric Infectious Diseases, Department of Pediatrics and Child Health, Section

[1] Nizet V, Klein JO. Bacterial sepsis and meningitis. In: Remington JS, Klein JO, Wilson CB, Nizet V, Maldonado YA, editors. Infectious Diseases of the Fetus and Newborn

[2] Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: A review of evidence from community-based studies. Pediatric Infectious Disease Journal.

[3] Edwards MS, Baker CJ. Bacterial meningitis in the neonate: Clinical features and diagnosis. In: Post TW, ed. UpToDate [database on the Internet]. Waltham (MA): UpToDate;

[4] Furyk JS, Swann O, Molyneux E. Systematic review: Neonatal meningitis in the developing world. Tropical Medicine and International Health. 2011;**16**:672-679. DOI:

[5] UNICEF Türkiye. Türkiye'de 5 Yaş Altı Ölüm Hızında (5YAÖH) Azalma: Bir Durum

of Internal Medical Sciences, Kocaeli University Faculty of Medicine, Kocaeli, Turkey

Infant. 7th ed. Philadelphia, PA: Elsevier Saunders; 2011. pp. 222-275

2009;**28**(Suppl. 1):S3-S9. DOI: 10.1097/INF.0b013e3181958755

Araştırması. 1st ed. Ankara, Turkey: UNICEF; 2009. pp. 29-35

2017 [cited 12 February 2017]

10.1111/j.1365-3156.2011.02750.x

in this field [24, 25].

**Conflict-of-interest**

**Author contribution**

approval of the final version.

**Author details**

Selim Öncel

**References**

No potential conflicts of interest. No financial support.

Address all correspondence to: selimoncel@doctor.com

**Table 3.** Dosages (mg/kg) of some antibacterial drugs used for neonatal meningitis [15].

for well-appearing infants with negative blood and CSF cultures and negative inflammatory findings in CSF may safely be discontinued 48–72 h after receiving negative CSF culture results from the microbiology laboratory [10].

LP should be repeated after 24–48 h after the beginning of antimicrobials for CSF is expected to become sterile in 24–48 h with appropriate therapy. In some centers, successful therapy for HSV meningitis is confirmed with a negative polymerase chain reaction in CSF, obtained with a repeat LP at the end of a 21-day antiviral therapy.
