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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)
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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
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3
Q

Gram stain of S. agalactiae

A
  • Gram pos diplococci

- Part of group B strep family

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4
Q

Gram stain of N. meningitidis

A

Gram neg diplococci

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5
Q

Gram stain of H. influenzae

A

Gram neg rod

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6
Q

Gram stain of Listeria monocytogenes

A

Gram pos bacilli

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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)
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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
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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
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10
Q

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

A

Helps antibiotics enter CSF b/c it weakens tight junctions

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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
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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
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13
Q

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

A

Cefotaxime/ ceftriaxone + vanco

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14
Q

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

A
  • Cefotaxime/ ceftriaxone + vanco + ampicillin

- Ampicillin covers listeria

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15
Q

What therapy would be used for listeria meningitis?

A

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

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16
Q

Empirical antimicrobial therapy for healthcare-associated meningitis?

A

(Meropenem or ceftazidime) + vanco

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17
Q

Empirical antimicrobial for meningitis in immunocompromised?

A

Meropenem + vanco + ampicillin

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18
Q

Dosing of cefotaxime for meningitis?

A

2 g q4h

19
Q

Dosing of ceftriaxone for meningitis?

A

2 g q12h

20
Q

Dosing of ampicillin for meningitis?

A

2 g q4h

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?

A

2 g q8h

23
Q

Dosing of ceftazadime for meningitis?

A

2 g q8h

24
Q

Dosing of penicillin G for meningitis?

A

4 million units q4h

25
Q

Dosing of rifampin for meningitis?

A

600 mg q24h

26
Q

What is the antimicrobial therapy for S. pneumoniae meningitis (Pen-S, MIC < 0.06)?

A

Pen G or ampicillin

27
Q

What is the antimicrobial therapy for S. pneumoniae meningitis (Pen-R, MIC > 0.12)?

A

Cefotaxime/ ceftriaxone

28
Q

What is the antimicrobial therapy for S. pneumoniae meningitis (3rd gen cephalosporin, MIC > 1)?

A

Cefotaxime/ ceftriaxone + vanco

29
Q

What is the antimicrobial therapy for S. pneumoniae meningitis (3rd gen cephalosporin, MIC > 2)?

A

Cefotaxime/ ceftriaxone + vanco + rifampin

30
Q

What are the alternatives for S. pneumoniae meningitis? What is the duration of therapy?

A
  • Duration = 10-14 days

- Alternatives = levo/ moxi + vanco; [chloramphenicol, linezolid]

31
Q

What is the antimicrobial therapy for N. meningitidis meningitis (Pen-S, MIC < 0.06)?

A

Pen G or ampicillin

32
Q

What is the antimicrobial therapy for N. meningitidis meningitis (Pen-RS, MIC 0.12-1)?

A

Cefotaxime/ ceftriaxone

33
Q

What are the alternatives for N. meningitidis meningitis? What is the duration of therapy?

A
  • Duration = 5-7 days

- Alternatives = cipro; [chloramphenicol]

34
Q

What is the antimicrobial therapy for L. monocytogenes meningitis? What is the duration?

A
  • (Pen G or amp) + gent
  • [TMP-SMX, linezolid]
  • Duration = at least 21 days
35
Q

What is the antimicrobial therapy for H. influenzae meningitis (Amp-S)?

A

Ampicillin

36
Q

What is the antimicrobial therapy for H. influenzae meningitis (Amp-R, non-beta-lactamase)?

A

Cefotaxime/ ceftriaxone

37
Q

What is the antimicrobial therapy for H. influenzae meningitis (Amp-R, beta-lactamase)?

A

Meropenem

38
Q

What are the alternatives for H. influenzae meningitis?

A

Cipro; [chloramphenicol]

39
Q

What is the antimicrobial therapy for S. agalactiae meningitis? What is the duration?

A
  • (Pen G or amp) + gent x 5 d
  • [Vanco, chloramphenicol]
  • Duration = 14-21 days (pen G or amp)
40
Q

What is the timeline for response for meningitis?

A
  • 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
Q

When is dexamethasone adjunctive therapy recommended for meningitis?

A
  • Immunocompetent adults w/ suspected or proven pneumococcal meningitis
  • Infants or children w/ H. influenzae or pneumococcal meningitis
42
Q

What is the dosage and duration of dexamethasone for meningitis?

A
  • 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
Q

What are some ways to prevent meningitis?

A

Vaccinations (H. influenzae, pneumococcal conjugate 13 valent, meningococcal C conjugate, and pneumococcal polysaccharide)

44
Q

When is meningococcal prophylaxis recommended and which antimicrobials are used?

A
  • 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)

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