Bacterial infections of the central nervous system are a neurological emergency. Prompt recognition and treatment are not only essential to prevent mortality but also to decrease neurological sequelae. This chapter will focus on the two most common central nervous system bacterial infections, bacterial meningitis and spinal epidural abscess. The eradication of the pathogen with antimicrobial therapy is the easy part. It is the recognition of the disorder, the understanding of the diagnostic studies and their limitations, and the management of the neurological complications that requires the expertise of a neurologist. Adult: 12 g/d (q4-6h) Cefepime Infants and children: 150 mg/kg/d (q8h) Adult: 6 g/d (q8h) Cefotaxime Infants and children: 225-300 mg/kg/d (q6-8h) Adult: 8-12 g/d (q4-6h) Ceftriaxone Infants and children: 80-100 mg/kg/d (q12h) Adult: 4 g/d (q12h) Gentamicin Infants and children: 7.5 mg/kg/d (q8h) Adult: 5 mg/kg/d (q8h) Meropenem Infants and children: 120 mg/kg/d (q8h) Adult: 6 g/d (q8h) Metronidazole Infants and children: 30 mg/kg/d (q6h) Adult dose: 2000 mg/day (q6h) Nafcillin Infants and children: 200 mg/kg/d (q6h) Adult: 9-12 g/d (q4h) Penicillin G Infants and children: 0.3 mU/kg/d (q4-6h) Adult: 24 million units/d (q4-6h) Rifampin Infants and children: 10-20 mg/kg/d (q12-24h) Adults: 600-1200 mg/d (q12h) Vancomycin* Infants and children: 60 mg/kg/d (q6h) Adults: 45-60 mg/kg/d (q6-12h) Chemoprophylaxis Neisseria meningitidis Rifampin 600 mg twice daily for two days or Ceftriaxone 250 mg intramuscular or *Intraventricular vancomycin administration: children 10 mg/d, adults 20 mg/d Etiological organism