The combination of meropenem and vancomycin is not routinely recommended over ceftriaxone monotherapy for meningitis following neurosurgical intervention according to UK guidelines.
For bacterial meningitis, ceftriaxone at the highest doses recommended by the BNF or BNFC is the standard first-line treatment for common causative organisms such as Streptococcus pneumoniae, Haemophilus influenzae type b, group B streptococcus, and Enterobacterales (coliforms) NICE NG240.
Meropenem is considered an alternative to ceftriaxone or cefotaxime specifically for meningitis caused by Enterobacterales (coliforms), but only after antibiotic sensitivities are reviewed and with specialist advice NICE NG240.
Vancomycin is not mentioned as a routine addition to meropenem or ceftriaxone in the UK guideline for meningitis treatment post-neurosurgery, and there is no evidence presented that the combination of meropenem and vancomycin is more effective than ceftriaxone monotherapy.
Therefore, ceftriaxone monotherapy remains the recommended initial treatment unless there are specific indications or resistance patterns that necessitate alternative agents, in which case specialist infectious disease advice is advised NICE NG240.