Infections: CNS ABx Flashcards
What is the initial (prior to hospital) management of meningitis of unknown cause?
Benzylpenicillin sodium
Cefotaxime if pen allergic (non-severe).
Chloramphenicol if history of reactions to both pen and ceph.
What is the initial (prior to hospital) management of meningitis of unknown cause? (Pen allergy non-severe)
Benzylpenicillin sodium
Cefotaxime if pen allergic (non-severe).
Chloramphenicol if history of reactions to both pen and ceph.
What is the initial (prior to hospital) management of meningitis of unknown cause? (Allergy to Pens + Cephs)
Benzylpenicillin sodium
Cefotaxime if pen allergic (non-severe).
Chloramphenicol if history of reactions to both pen and ceph.
In hospital, if pneumococcal meningitis is suspected in adults, adjunctive treatment with what should be considered?
In hospital, consider adjunctive treatment with dexamethasone (particularly if pneumococcal meningitis suspected in adults), preferably starting before or with first dose of antibacterial, but no later than 12 hours after starting antibacterial; avoid dexamethasone in septic shock, meningococcal septicaemia, or if immunocompromised, or in meningitis following surgery.
In hospital, meningitis (aetiology unknown), what is the treatment choice and duration in Adults and children 3 months - 50 years?
Cefotaxime (or ceftriaxone).
Vancomycin added if prolonged or multiple use of other antibacterials in the last 3 months, or if travelled, in the last 3 months to areas outside the UK with highly penicillin and cephalosporin-resistant pneumococci.
10 day suggested treatment duration.
In hospital, meningitis (aetiology unknown), what is the treatment choice and duration in Adults over 50 years?
Cefotaxime (or ceftriaxone) + amoxicillin (or ampicillin).
Vancomycin added if prolonged or multiple use of other antibacterials in the last 3 months, or if travelled, in the last 3 months to areas outside the UK with highly penicillin and cephalosporin-resistant pneumococci.
10 day suggested treatment duration.
What is the treatment of meningitis caused by meningococci?
Duration of treatment?
Benzylpenicillin sodium or cefotaxime (or cefrtriaxone).
7 days.
Chloramphenicol if immediate hypersensitivity reaction to penicillin or cephalosporins. Still 7 days.
What is the treatment of meningitis caused by meningococci in pen/ceph allergic patients?
Chloramphenicol if immediate hypersensitivity reaction to penicillin or cephalosporins. Still 7 days.
What is the treatment of choice of meningitis caused by pneumococci?
What if the organism is penicillin-sensitive?
What if the organism is penicillin-resistant?
What adjunctive treatment?
What duration?
Cefotaxime (or ceftriaxone).
Replace cefotaxime with benzylpenicillin if organism penicllin susceptible.
Add in vancomycin and if necessary rifampicin if organism is resistant.
14 day treatment.
Consider adjunctive treatment with dexamethasone, preferably starting before or with first dose of antibacterial, but no later than 12 hours after starting antibacterial (may reduce penetration of vancomycin into cerebrospinal fluid).
What is the treatment of meningitis caused by Haemophilus infuenzae?
Any adjunctive treatment?
Duration?
What if H.influenzae type b in those under 10 or with vulnerable house contacts?
Cefotaxime (or ceftriaxone)
Consider adjunctive treatment with dexamethasone, preferably starting before or with first dose of antibacterial, but no later than 12 hours after starting antibacteria
10 days
For Hib, give rifampicin for 4 days before discharge from hospital to those under 10 or to those in contact with vulnerable household contacts.
What is the treatment of non-pen allergic patients with meningitis caused by Listeria?
Amoxicillin (or ampicillin) + gentamicin.
21 days.
Consider stopping gent after 7 days.
What is the treatment and duration of treatment for non-pen allergic patients with meningitis caused by Listeria?
Amoxicillin (or ampicillin) + gentamicin.
21 days.
Consider stopping gent after 7 days.
What is the treatment of pen-allergic patients with meningitis caused by Listeria?
Co-trimoxazole.
Suggested duration, 21 days.
