Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Year 3 - Clinical > 8 - Meningitis > Flashcards

8 - Meningitis Flashcards

1
Q

What are the risk factors for meningitis?

A
  • Nasopharyngeal colonization w/ N. meningitides, S. pneumoniae, H. influenzae
  • Prior URTI, cochlear implants
  • Cranial anatomical defects, trauma, fracture, neurosurgery, prosthesis drains
  • Neonates, advanced age, pregnancy
  • Immunocompromised (HIV, malignancy, chemotherapy, corticosteroids, splenectomy)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

What are the most likely pathogens of meningitis according to pt age?

A
  • Neonates = S. agalactiae, E. coli
  • Children = N. meningitidis, S. pneumoniae; H. influenzae if unvaccinated
  • Adolescents/ young adults = S. pneumoniae, N. meningitidis
  • Neonates, advanced age > 60 y/o, immunocompromised, pregnancy = L. monocytogenes
  • Immunocompromised, health-care associated = S. aureus, gram neg bacilli
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Gram stain of S. agalactiae

A
  • Gram pos diplococci

- Part of group B strep family

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

Gram stain of N. meningitidis

A

Gram neg diplococci

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

Gram stain of H. influenzae

A

Gram neg rod

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

Gram stain of Listeria monocytogenes

A

Gram pos bacilli

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

What are the most common clinical signs of meningitis?

A
  • Fever > 40 C
  • Nuchal rigidity or neck stiffness
  • CNS (headache, photophobia, confusion, reduced consciousness, seizures)
  • Neonates = non-specific sx +/- fever, seizures, respiratory distress, septic shock
  • CSF = protein elevated and low glucose
  • Skin lesions may indicate N. meningitidis or H. influenzae involvement (rarely occur w/ pneumococcal)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What are some possible complications of meningitis?

A
  • Herniation – diffuse swelling, hydrocephalus
  • Infarction – inflammatory occlusion of basal arteries
  • Seizures (cortical inflammation)
  • Significantly influenced by pathogen, pt age, health status, and tx
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are the antimicrobial fundamentals for meningitis?

A
  • Early, prompt initiation
  • CSF penetration (molecular size, lipophilicity, ionization, protein binding; barrier inflammation)
  • Rapid sterilization
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What role does inflammation play in penetration of antibiotics in CSF?

A

Helps antibiotics enter CSF b/c it weakens tight junctions

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

Empirical antimicrobial therapy for meningitis in infants under 1 month?

A
  • Cefotaxime + ampicillin +/- gentamicin
  • Gent added to make cefotaxime cidal against group B strep
  • Aminoglycosides don’t cross CSF, but in this case are being used for synergy so much lower levels are needed
  • Can’t use ceftriaxone b/c of calcium binding and depositing in soft tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Empirical antimicrobial therapy for meningitis in children 1 month to 17 years?

A
  • Cefotaxime/ ceftriaxone + vanco
  • Cefotaxime/ ceftriaxone for neisseria
  • Vanco used for PRSP w/ reduced susceptibility to 3rd gen cephalosporins
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Empirical antimicrobial therapy for meningitis in 18-50 y/o?

A

Cefotaxime/ ceftriaxone + vanco

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Empirical antimicrobial therapy for meningitis in over 50 y/o?

A
  • Cefotaxime/ ceftriaxone + vanco + ampicillin

- Ampicillin covers listeria

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

What therapy would be used for listeria meningitis?

A

Ampicillin, but since not cidal would be +/- gent

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

Empirical antimicrobial therapy for healthcare-associated meningitis?

A

(Meropenem or ceftazidime) + vanco

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

Empirical antimicrobial for meningitis in immunocompromised?

A

Meropenem + vanco + ampicillin

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

Dosing of cefotaxime for meningitis?

19
Q

Dosing of ceftriaxone for meningitis?

20
Q

Dosing of ampicillin for meningitis?

21
Q

Dosing of vancomycin for meningitis?

A

15-20 mg/kg q8h (troughs 15-20 mg/L)

22
Q

Dosing of meropenem for meningitis?

23
Q

Dosing of ceftazadime for meningitis?

24
Q

Dosing of penicillin G for meningitis?

A

4 million units q4h

25
Dosing of rifampin for meningitis?
600 mg q24h
26
What is the antimicrobial therapy for S. pneumoniae meningitis (Pen-S, MIC < 0.06)?
Pen G or ampicillin
27
What is the antimicrobial therapy for S. pneumoniae meningitis (Pen-R, MIC > 0.12)?
Cefotaxime/ ceftriaxone
28
What is the antimicrobial therapy for S. pneumoniae meningitis (3rd gen cephalosporin, MIC > 1)?
Cefotaxime/ ceftriaxone + vanco
29
What is the antimicrobial therapy for S. pneumoniae meningitis (3rd gen cephalosporin, MIC > 2)?
Cefotaxime/ ceftriaxone + vanco + rifampin
30
What are the alternatives for S. pneumoniae meningitis? What is the duration of therapy?
- Duration = 10-14 days | - Alternatives = levo/ moxi + vanco; [chloramphenicol, linezolid]
31
What is the antimicrobial therapy for N. meningitidis meningitis (Pen-S, MIC < 0.06)?
Pen G or ampicillin
32
What is the antimicrobial therapy for N. meningitidis meningitis (Pen-RS, MIC 0.12-1)?
Cefotaxime/ ceftriaxone
33
What are the alternatives for N. meningitidis meningitis? What is the duration of therapy?
- Duration = 5-7 days | - Alternatives = cipro; [chloramphenicol]
34
What is the antimicrobial therapy for L. monocytogenes meningitis? What is the duration?
- (Pen G or amp) + gent - [TMP-SMX, linezolid] - Duration = at least 21 days
35
What is the antimicrobial therapy for H. influenzae meningitis (Amp-S)?
Ampicillin
36
What is the antimicrobial therapy for H. influenzae meningitis (Amp-R, non-beta-lactamase)?
Cefotaxime/ ceftriaxone
37
What is the antimicrobial therapy for H. influenzae meningitis (Amp-R, beta-lactamase)?
Meropenem
38
What are the alternatives for H. influenzae meningitis?
Cipro; [chloramphenicol]
39
What is the antimicrobial therapy for S. agalactiae meningitis? What is the duration?
- (Pen G or amp) + gent x 5 d - [Vanco, chloramphenicol] - Duration = 14-21 days (pen G or amp)
40
What is the timeline for response for meningitis?
- Fever = resolution w/in 24-48 h - Neck stiffness = resolution over 48-72 h - CSF = culture negative w/in 24 h, normal glucose by day 3 and normal protein by day 7-10 - Rash = resolution over 7 days
41
When is dexamethasone adjunctive therapy recommended for meningitis?
- Immunocompetent adults w/ suspected or proven pneumococcal meningitis - Infants or children w/ H. influenzae or pneumococcal meningitis
42
What is the dosage and duration of dexamethasone for meningitis?
- 0.15 mg/kg q6h x 2-4 days initiated 10-20 min before or w/ 1st antibiotic dose - Only continue if gram pos diplococci (S. agalactiae) or S. pneumoniae culture
43
What are some ways to prevent meningitis?
Vaccinations (H. influenzae, pneumococcal conjugate 13 valent, meningococcal C conjugate, and pneumococcal polysaccharide)
44
When is meningococcal prophylaxis recommended and which antimicrobials are used?
- For pt w/ close contacts w/in 60 days - Cipro 500 mg po x 1 dose - Rifampin 600 mg po q12h x 4 doses - Ceftriaxone 250 mg IM x 1 dose

Year 3 - Clinical (30 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions