Exam 2 meningitis stuff Flashcards
pediatric risk factors for meningitis
age <2 years (especially < 3 months)–> less developed immune system
incomplete immunizations (add Hib, pneumococcal)
immunocompromised
medical devices– CSF shunts, cochlear implants
perinatal period
meningitis pathophysiology
nasopharyngeal colonization–> inflammation–> access to bloodstream –> spread to CNS–> pathogen evades immune system
direct inoculation (CSF catheter, trauma), ear infection
CSF changes in bacterial meningitis
WBC 1000-5000
Differential >80 PMNs
Protein 100-500
Glucose < 40
when is there clinical suspicion for virus
focal neurologic deficits, seizures, depressed mental status
what to do for clinical suspicion of virus
add IV acyclovir until HSV eliminated
what are the common pathogens for bacterial meningitis for ages 1-23 months old
S. pneumoniae
N. meningitidis
H. influenzae
S. agalactiae
empiric therapy for bacterial meningitis
vancomycin + 3rd generation cephalosporin (cefotaxime, ceftriaxone)
what are the empiric antibiotic considerations for bacterial meningitis
distribution to CSF (poor penetration with hydrophilic drugs)
max high doses, IV, bactericidal, do not delay
ceftriaxone dose
80-100 mg/kg/day divided q12-24h
vancomycin dose
15 mg/kg/dose q6h
dexamethasone or not?
there is no benefit in children with bacterial meningitis due to pathogens OTHER than H. influenzae
dexamethasone dosing when it is used
0.15 mg/kg/dose q6h for the first 2-4 days of antibiotic treatment
start 10-20 minutes before or with the first dose of antibiotic
if antibiotics have already been administered do we use dexamethasone
no
recommendation for children <5 years old not vaccinated for Hib
receive adjunctive therapy with dexamethasone administered before or at the same time as the first dose of antimicrobial therapy
anti infective prophylaxis for close contacts
rifampin 20 mg/kg/dose once a day for 4 days
