Infections: Meningitis and CAP Flashcards
What is the most common pathogen causing bacterial meningitis in neonates?
Group B streptococcus
What are pregnant women engaged in prenatal care tested for to prevent transmission?
Group B streptococcus
T/F: Upon delivery, GBS (+) mothers should not be treated with antibiotics as to avoid adverse outcomes for the baby.
FALSE: GBS positive mothers should be treated with antibiotics at delivery
What are the two most common pathogens causing bacterial meningitis in 1-23 month-olds?
S. pneumoniae
Neisseria meningitidis
What are risk factors for meningitis in neonates?
- Infections/trauma around delivery time
- Low birth weight
What are risk factors for meningitis in children?
- Immunocompromising conditions (anemia, HIV, asplenia)
- Lack of immunizations
- Daycare
What does an infant presentation of meningitis look like?
- Poor feeding, vomiting
- Temperature instabilities
- Seizures
- Bulging fontanelle
- Lethargy, irritability
What are ADDITIONAL s/s that may be seen in children with meningitis?
- Photophobia
- Stiff neck
- Headache
What is the gold standard for bacterial meningitis diagnosis?
CSF positive culture from lumbar puncture
What are CSF findings of BACTERIAL meningitis?
- Low glucose
- High protein
- High WBC
What are CSF findings of VIRAL meningitis?
- Normal glucose
- Low to normal protein
- High WBC but not as high as bacterial
How should bacterial meningitis be treated in neonates?
Ampicillin + AG
or
Ampicillin + cefotaxime (if renal issues)
What additional drug should be used for empiric therapy in neonatal meningitis if HSV is suspected?
Acyclovir
How should bacterial meningitis be treated in ages 1 and up?
Vancomycin + cefotaxime
or
Vancomycin + ceftriaxone
Which drug causes hyperbilirubinemia and should be avoided in neonates?
Ceftriaxone
What is the AUC/MIC target for vancomycin in pediatrics?
400-600 AUC/MIC
What are the ADEs to look out for with vancomycin?
Nephrotoxicity, infusion reactions, ototoxicity
If used, when should dexamethasone be administered?
10-20 min before or with the 1st dose of antibiotics
No benefit after 1 hour of antibiotics
How might dexamethasone be helpful in children and infants >6 weeks with bacterial meningitis?
To decrease hearing loss in patients with H. influenza meningitis (NOT NEONATES)
What are IDSA indications for dexamethasone in the setting of pediatric meningitis?
- H. influenzae suspected, before antibiotics
- Consider if s. pneumoniae and high risk of mortality
What is the most common comorbidity that leads to CAP?
Asthma
What are the 3 routes of entry for pathogens causing CAP?
- Inhaled aerosolized particles
- Through bloodstream
- Aspiration
What are the hallmark s/s of CAP that must be present for diagnosis?
- Fever
- Cough
What is the gold standard for bacterial CAP diagnosis?
Chest X-ray lobar or confuse consolidation in one lobe of the lung
How does a viral CAP infection look on a chest X-ray?
General haziness throughout both lungs
What diagnostics are rarely drawn/used for CAP?
- Blood cultures
- Sputum cultures
Who should be hospitalized for CAP?
- Moderate-severe
- Respiratory distress (O2 < 90%)
- Infants <3 months
- Infants <6 months with suspected bacterial CAP
- Suspicion or documentation of MRSA
- Caretaker capability concern
- Underlying medical conditions
What is the best predictor of pathogen identification in CAP?
AGE
What is the most common pathogen for CAP across all age groups up to 15?
S. pneumoniae
T/F: Viruses such as RSV are significant causes of CAP in young children and infants.
TRUE
When do atypical bacteria begin to enter the suspected pathogen pool and become more common for CAP? (M. pneumoniae, C. pneumoniae)
5 years of age
When should CAP symptoms resolve with appropriate treatment?
2-3 days
What are the 1st and 2nd line treatments for outpatient bacterial CAP outpatient?
- Amoxicillin PO 90 mg/kg/day in 2 doses
- Augmentin PO 90 mg/kg/day in 2 doses
What is the first line treatment for presumed atypical CAP outpatient?
Azithromycin PO 10 mg/kg on day 1, followed by 5 mg/kg on days 2-5
T/F: Azithromycin and penicillins should not be used together to treat CAP.
FALSE: Azithromycin can be added on to the first line treatment if bacterial vs. atypical is ambiguous
What treatment should be used for inpatient CAP who is fully immunized and lives in an area where the local penicillin resistance is minimal (MIC <2)
Ampicillin IV* or penicillin G IV
What treatment should be used for inpatient CAP who is NOT fully immunized OR lives in an area where the local penicillin resistance is HIGH (MIC >2)
Ceftriaxone IV* or cefotaxime IV
Why do we use high dose amoxicillin/augmentin to treat CAP?
To overcome s. pneumoniae mechanism of resistance - penicillin-binding proteins
What does the clavulanate offer in augmentin?
Coverage of B-lactamase producing organisms (H. influenzae)
Why is the ES formulation preferred for high-dose augmentin/amoxicillin?
To minimize supratherapeutic concentrations of clavulanate
Why does azithromycin have such a short treatment course?
Its long half life produces a post-antibiotic effect
Why is ceftriaxone used in un-immunized children?
Concern for H. influenzae (B-lactamase-producing)
What is the viral influenza treatment that should be used within 48 hours of symptoms to be effective?
Oseltamivir - 5 day course
What is the IDSA recommended treatment duration for CAP?
10 days
What should you switch to if a patient has a non-serious penicillin allergy?
Trial under medical supervision:
- Cephalosporins such as cefpodoxime, cefprozil, cefuroxime
What should you switch to if a patient has a history of anaphylaxis to penicillin?
- Levofloxacin
- Linezolid
- Macrolide
- Clindamycin
- Bactrim
