Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Clinical 2 - Antibiotics > 8 - Meningitis > Flashcards

8 - Meningitis Flashcards

1
Q

What are the risk factors for meningitis ?

A
  • neonates, advanced age, pregnancy (prob a type of immune deficiency)
  • nasopharyngeal colonization with N. meningitides, S. pneumonia, H. influenzae
  • prior URTI, cochlear implants
  • cranial anatomical defects, trauma, fracture, neurosurgery, prosthesis, drains
  • immunocompromised
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the pathophysiology of meningitis

A
  • entry of multiplication of bacteria in CSF
  • lysis of bacteria
  • increases coagulation
  • decreases fibrinolysis
  • BBB permeability
  • metabolic disturbances
  • brain damage
  • increased intracranial pressure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the most likely pathogens for meningitis ?

A

N. meningitidis
Strep pneumoniae
H. flu
L. monocytogenes (sandwich meat/pregnant ppl)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the most likely pathogens according to patient age:

Neonates ?

A

Neonates < 1 month:
S. agalactiae
E. coli

(less commonly - Strep pneumoniae, L monocytogenes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are the most likely pathogens according to patient age:

Children

A

N. meningitidis
S. pneumoniae

(H. flu if unvaccinated)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What are the most likely pathogens according to patient age:

Adults

A

N. meningitidis

S. pneumoniae

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What are the most likely pathogens according to patient age:

Pregnancy, advanced age > 60, immunocompromised

A

L. monocytogenes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are the most likely pathogens according to patient age:

Immunocompromised, HCA

A

S. aureus

GNB (gram negative bacilli)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

N. meningitides more common in _______

A

children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

S. pneumoniae is more common in ________

A

elderly

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

nuchal

A

pertaining to the spinal cord

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the 3 most common clinical signs of meningitis?

A

1) Fever > 40 in 90% of ppl
2) Nuchal rigidity or neck stiffness (80%)
3) CNS (80%) such as headache, photophobia, confusion, seizures, coma

  • 95% of cases with >2
  • 50% of cases with all 3
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some non-specific symptoms of meningitis?

A
  • fever
  • seizures
  • respiratory distress
  • septic shock in neonates
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What sign is HIGHLY suggestive of meningococcal infection?

A

RASH

-petechial or purpural rash present in >50% of meningococcal infections

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

What are the complications that can arise from meningitis? (3)

A

1) Herniation - diffuse swelling, hydrocephalus
2) Infarcts - inflammatory occlusion of basal arteries
3) Seizures - cortical inflammation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

see page 8 for mortalities

A

okay

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

A 21 yr old female gets meningitis - what are the most likely pathogens based on her age ?

A
  • N. Meningitidis

- Strep pneumo

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

List 3 antimicrobial fundamentals in treating meningitis?

A

1) Early, prompt initiation
2) CSF penetration (antibiotic size, lipophilicity, ionization, protein binding, barrier inflammation)
3) Rapid sterilization

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Delays in administration of antibiotic are associated with ______ from adult acute bacterial meningitis

A

mortality

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Why do we depend on inflammation in meningitis ?

A

We need to depend on the inflammation that occurs in these tight junctions that allow the drug to get through the BBB and the BCSFB.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Ceftriaxone is _% free

A

5

*this 5% that is free is therapeutic for meningitis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Which drugs are able to achieve therapeutic CSF concentrations with or without inflammation

A
  • Chloramphenicol
  • Metronidazole
  • Rifampin

“Connie Myers Rules” lol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Which drugs only achieve therapeutic CSF concentrations WITH inflammation?

A
  • Penicillins
  • 3rd GC & Cefuroxime
  • Daptomycin
  • Fluoroquinolones
  • Linezolid
  • Meropenem
  • TMP-SMX
  • Vancomycin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Which drugs will not achieve therapeutic CSF concentrations ?

A
  • Aminoglycosides

- other Cephalosporins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Empirical age based formula for meningitis:

< 1 month

A 
Cefotax (covers strep and pneumoniae)
\+
Amp (covers listeria)
\+/- 
Gent (this doesn't get into CSF ! sometimes penicillin can be less effective against GAS so Gent is added on)

Why not Ceftriax?

  • cannot be given with calcium
  • can displace bilirubin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

Empirical age based formula for meningitis:

1 month to 17 years

A

Cefotax / Ceftriax (covers strep and pneumoniae)
**Ceftriax can be used here !
+
Vanco (covers PRSP)
*This is only added on for the initial day or two until you know what the bug is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Empirical age based formula for meningitis:

18 - 50 years

A

Cefotax / Ceftriax (covers strep and pneumoniae)
+
Vancomycin (covers PRSP)
*This is only added on for the initial day or two until you know what the bug is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Empirical age based formula for meningitis:

> 50 years

A

Cefotax / Ceftriax (covers strep and pneumoniae)
+
Vancomycin (covers PRSP)
*This is only added on for the initial day or two until you know what the bug is
+
Amp (covers L. monocytogenes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Treatment for:

HCA meningitis

A

Mero (to cover all the other possible drugs) or Ceftaz
+
Vanco (covers PRSP)
*This is only added on for the initial day or two until you know what the bug is

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

Treatment for:

Immunocompromised

A

Mero (to cover all the other possible drugs)
+
Vanco (covers PRSP)
*This is only added on for the initial day or two until you know what the bug is
+
Amp (to cover L. monocytogenes)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Meningitis dose:

Cefotaxime

A

2 g q4h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

Meningitis dose:

Ceftriaxone

A

2g q12h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

Meningitis dose:

Ampicillin

A

2g q4h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

Meningitis dose:

Vanco

A

15-20 mg/kg q8h

troughs 15-20 mg/L

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

Meningitis dose:

Meropenem

A

2g q8h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

Meningitis dose:

Ceftazidime

A

2g q8h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

Meningitis dose:

Penicillin G

A

4 MU q4h

Max dose on sheet!

38
Q

Meningitis dose:

Rifampin

A

600 mg q24h

same as on sheet, don’t need to memorize!

39
Q

Meningococcal meningitis:

Peak in ?

A

late winter and early spring

40
Q

Meningococcal meningitis:

Predominantly Group __

A

B

41
Q

Meningococcal meningitis:

Peak incidence in who ?

A

children and young adults

60% of cases in 2-18 years

42
Q

Meningococcal meningitis:

Colonization in _____% of adolescents and adults

A

10-20

43
Q

Meningococcal meningitis:

Natural immunity in __% by 2 years of age

A

80%

44
Q

N. meningitidis:
Pen-S

1st line ?

A

Pen G or Amp

45
Q

N. meningitidis:
Pen-S

Alternatives ?

A

Cipro

46
Q

N. meningitidis:
Pen-RS

1st line ?

A

Cefotax / Ceftriax

47
Q

N. meningitidis:
Pen-RS

Alternatives ?

A

Chloram

48
Q

N. meningitidis:

Duration of treatment ?

A

5-7 days

49
Q

S. pneumoniae:
Pen-S

1st line ?

A

Pen G or Amp

50
Q

S. pneumoniae:
Pen-S

Alternatives ?

A

Levo/Moxi +/- Vanco

[Chloram, Linezolid]

51
Q

S. pneumoniae:
Pen-R

1st line ?

A

Cefotax / Ceftriax

52
Q

S. pneumoniae:
Pen-R

Alternatives ?

A

Levo/Moxi +/- Vanco

[Chloram, Linezolid]

53
Q

S. pneumoniae:
3rd GC, MIC >1

1st line ?

A

Cefotax / Ceftriax
+
Vanco

54
Q

S. pneumoniae:
3rd GC, MIC >1

Alternatives ?

A

Levo/Moxi +/- Vanco

[Chloram, Linezolid]

55
Q

S. pneumoniae:
3rd GC, MIC >2

1st line ?

A 
Cefotax/ Ceftriax
\+
Vanco
\+
Rifampin
56
Q

S. pneumoniae:
3rd GC, MIC >2

Alternatives ?

A

Levo/Moxi +/- Vanco

[Chloram, Linezolid]

57
Q

S. pneumoniae:

Duration of therapy ?

A

10-14 days

58
Q

L. monocytogenes:

1st line ?

A

Pen G + Gent
OR
Amp + Gent

59
Q

L. monocytogenes:

Alternatives ?

A

TMP-SMX

[Linezolid]

60
Q

L. monocytogenes:

Duration of therapy ?

A

> 21 days

61
Q

H. influenzae:
Amp-S

1st line ?

A

Amp

62
Q

H. influenzae:
Amp-S

Alternatives ?

A

Cipro

[Chloram]

63
Q

H. influenzae:
Amp-R, non-beta lactamase

1st line ?

A

Cefotax / Ceftriax (bc they have increased GN coverage to cover H. flu)

64
Q

H. influenzae:
Amp-R, non-beta lactamase

Alternatives ?

A

Cipro

[Chloram]

65
Q

H. influenzae:
Amp-R, B-lactamase

1st line ?

A

Mero

66
Q

H. influenzae:
Amp-R, B-lactamase

Alternatives ?

A

Cipro

[Chloram]

67
Q

H. influenzae:

Duration of therapy ?

A

7 - 10 days

68
Q

S. agalactiae:

1st line ?

A

Pen G (+ Gent x 5 days)
OR
Amp (+ Gent x 5 days)

69
Q

S. agalactiae:

Alternatives ?

A

Vanco

[Chloram]

70
Q

S. agalactiae:

Duration of therapy ?

A

14-21 days

71
Q

Streptococcal meningitis:

Invasive disease in _____

A

Manitoba

72
Q

Streptococcal meningitis:

Declining incidence as a result of ?

A

conjugate vaccination

73
Q

Streptococcal meningitis:

Increasing incidence of ?

A

non-included serotypes

74
Q

What is the role of adjunctive dexamethasone therapy ?

A
  • RR mortality = 0.48

- Post-hoc analysis showed benefit in pneumococcal disease only

75
Q

Who is adjunctive dexamethasone therapy recommended for?

A

-immunocompetent adults with suspected or proven pneumococcal meningitis, and infants or children with H. influenzae (or pneumococcal ?) meningitis based on prior data

76
Q

What is the dose for Dexamethasone ?

A

0.15 mg/kg q6h x 2-4 days initiated 10-20 min before or with 1st antibiotic dose

77
Q

Dexamethasone therapy:

Continue only if ?

A

GPDC on gram stain or S. pneumonia culture

78
Q

Dexamethasone therapy:

There are concerns regarding reducing antibiotic penetration of which drugs ?

A

Vancomycin and possibly Rifampin

79
Q

If they already had a dose of antibiotics, do you still give Dex ?

A

No - it is ineffective now

80
Q

What is the point of giving Dex ?

A
  • steroids decrease inflammation

- reduce amount of hearing issues after meningitis (especially in kids)

81
Q

Meningitis Monitoring:

When should fever resolve ?

A

within 24-48 hours

82
Q

Meningitis Monitoring:

When should neck stiffness resolve ?

A

over 48 - 72 hours

83
Q

Meningitis Monitoring:

When should CSF show a culture negative ?

A

within 24 hours

84
Q

Meningitis Monitoring:

When should glucose be normal ?

A

3 days

85
Q

Meningitis Monitoring:
When should
When should protein be normal ?

A

7 - 10 days

86
Q

Meningitis Monitoring:

When should RASH resolve ?

A

over 7 days

87
Q

Chemoprophylaxis for who ?

A

For those whose close contacts have had meningococcal infections within the past 60 days

88
Q

What is the treatment for Chemoprophylaxis for Meningitis ?

just list them

A
  • Cipro
  • Rifampin
  • Ceftriaxone
89
Q

Dose of Cipro for Chemoprophylaxis

A

Adults:
500 mg PO x 1 dose

Children:
10 mg/kg PO x 1 dose (max 500 mg)

90
Q

Dose of Rifampin for Chemoprophylaxis

A

Adults:
600 mg PO q12h x 4 doses

Children 3 months - 12 years:
10mg/kg PO q12h x 4 doses

91
Q

Dose of Ceftriaxone for Chemophrophylaxis

A

Adults:
250 mg IM x 1 dose

Children under 12:
125 mg IM x 1 dose

Clinical 2 - Antibiotics (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions