The choice of antibiotics for bacterial meningitis depends on several factors, including the patient's age, risk factors, and local bacterial resistance patterns. Initially, broad-spectrum antibiotics are used to cover the most likely pathogens. Common choices include third-generation cephalosporins like ceftriaxone, often combined with vancomycin to cover drug-resistant bacteria. For older adults or those with weakened immune systems, ampicillin may be added to target Listeria monocytogenes.

Studies have shown that delays in antibiotic administration can significantly increase mortality rates. Ideally, antibiotics should be started within one hour of the patient's arrival at the hospital. In some cases, antibiotics may even be given before diagnostic tests are completed if bacterial meningitis is strongly suspected. This approach, known as empiric therapy, can be life-saving.

Once the specific bacteria causing the infection is identified through lab tests, the antibiotic regimen may be adjusted. This targeted approach, called directed therapy, ensures the most effective treatment while reducing the risk of antibiotic resistance. The duration of antibiotic treatment typically ranges from 7 to 21 days, depending on the type of bacteria and the patient's response to treatment.

Rapid, appropriate antibiotic therapy is the cornerstone of bacterial meningitis treatment, significantly improving patient outcomes.