EXAM 5 mikesell Flashcards
Drugs able to get through w/ or w/o meninges inflammation
Acyclovir
TMP/SMX
Voriconazole
Fluconazole
Ganciclovir
Linezolid
Metronidazole
FQ
Drugs able to get through w/ meninges inflammation
Penicillins
Ceftriaxone
Cefepime
3/4 cephalosporins
Aztreonam
Meropenem
Vancomycin
Drugs that cannot get through CSF
Macrolides
AMGs
B-lactamase inhibitors
1/2 cephalosporins
Clindamycin
Tetracyclines
Echinocandins
Ertapenem
Types of acute bacterial meningitis
hematogenous: bacteria gain access through CSF
direct innoculation: head trauma/ neurosurgery –> spread from parameningeal focus
Acute bacterial meningitis diagnosis
lumbar puncture
start empiric ABX after puncture
empiric ABX - neonates (<1 month)
ampicillin + ceftriaxone/cefepime
ampicillin + aminoglycoside
empiric ABX - infants (1-23 months) children+ adults (2-50 years)
vancomycin + ceftriaxone
empiric ABX - older adults immunocompromised
vancomycin + ceftriaxone + ampicillin
bacterial meningitis CSF interpretation
WBCS elavated (1000-5000)
neutrophils >80%
protein >150 elavated
blood glucose <50 decreased
role of steroids
consider in children > 2 months suspected with meningitis
fungal infections CSF interpretation
WBC elevated (10-500)
Lymphs >50%
protein 40-150 elevated
glucose <30-70 decreased
streptococcus
gram + diplococci pairs and chains
penicillin G or ampicillin
add dexamethasone
staph aureus
gram + cocci in clusters
MSSA - nafcillin
MRSA - vancomycin
listeria monocytogenes
gram + rod, non-spore forming
ampcillin + gentamicin
neiseria meningitidis
gram (-) intraceullar diplococci
pen G or ampicillin
ceftriaxone
h. flu
gram (-) coccobacillus
b-lactamase negative: ampicillin
b-lactamase positive: ceftriaxone
fungal meningitditis treatment
induction: amphotericin + flucytosine
consolidation: fluconazole QD
maintenance: fluconazole QD
viral encephalitis
supportive care - fluids, analgesia
HSV/VZV - acyclovir
CMV - ganciclovir
