ID

Question 1

RF neonatal sepsis + micro causes + Mx

Answer 1

prematurity
LBW
maternal chdorioamnionitis
PROM

Causes

• GBS
• E.coli

other GNB

• klebisiella
• acintobacter

staph aureus

Abx therapy

• recommended to treat if suspect
• safe to stop abx after 2-3 days if cultures negative
• risk of abx → NEC + death

Question 2

neonatal most common causes of meningitis vs post neonatal + how to Rx

Answer 2

neonatal meningitis

• e.coli
• GBS = strep agalactiae (listeria - requires penicillin for Rx)

Rx IV 3rd gen cephalosporin + amp

post neonatal meningitis (>3 months)

s. pneumoniae
n. meningiditis

Rx IV 3rd gen cephalosporin
+ vancomycin

Question 3

key causes of meningitis (neonate + child) + their gram stain appearances

Answer 3

GBS - GPC in chains
strep. pneumoniae - GPC pairs/diplococci
listeria - G+ cocco-bacilli
e.coli - GNB
s.aureus GPC in clusters
neiseria meningitis - GNB
HiB - G+ cocco-bacilli

Question 4

Treatment meningitis in children

Answer 4

GP/community empiric Rx
child <1 yo = 300mg IM benpen
1-9yo = 600mg
>9 yo or adult 1.2g

0 - 6mo: ampicillin + cefotaxime (to cover GBS, e coli, listeria, strep faecalis)

> 6mo: cefotaxime (meningococcus, pneumococcous, HiB)

pneumococcal or LP not done: cefotaxime + vanc (resistant pneumococcus)

eTG:
3rd gen cephalosporin (ceftriaxone/cefotaxime)
add vanc if GPC or known/suspected OM/sinusitis or recent betalactam Rx
+/- penicillin/ampicillin if <3mo or >50yo or immunocompromised, pregnant, etoh misuse, debilitated
(risk of listeria ∴ inherently resistent to listeria)

if due to resistant pneumococci
→ increase the dose of penicillin/ampicillin/cephalosporin
→ change to vanc + cefotaxime

NB: in ALL children >3mo w suspected or confirmed bacterial meningitis, give
Dexamethasone 0.15mg/kg QID for 4 days

Question 5

complications of bacterial meningitis

Answer 5

death 2-5%
ID, spasticity, seizures, hydrocephalus, deafness in 10 -15%
learning + behaviour disorder 25 - 45%

ALL NEED F/U AUDIOLOGY + DEVELOPMENTAL Ax

Question 6

chemoprophylaxis meningitis - when/who/which bacteria?

Answer 6

meningococcal infection

• rifampicin/ceftriaxone/ciproflox
• treat ALL household contacts

HiB
- rifampicin, only if child <4 yo