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704 Pediatrics > Infections: Meningitis and CAP > Flashcards

Infections: Meningitis and CAP Flashcards

1
Q

What is the most common pathogen causing bacterial meningitis in neonates?

A

Group B streptococcus

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2
Q

What are pregnant women engaged in prenatal care tested for to prevent transmission?

A

Group B streptococcus

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3
Q

T/F: Upon delivery, GBS (+) mothers should not be treated with antibiotics as to avoid adverse outcomes for the baby.

A

FALSE: GBS positive mothers should be treated with antibiotics at delivery

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4
Q

What are the two most common pathogens causing bacterial meningitis in 1-23 month-olds?

A

S. pneumoniae
Neisseria meningitidis

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5
Q

What are risk factors for meningitis in neonates?

A
  • Infections/trauma around delivery time
  • Low birth weight
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6
Q

What are risk factors for meningitis in children?

A
  • Immunocompromising conditions (anemia, HIV, asplenia)
  • Lack of immunizations
  • Daycare
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7
Q

What does an infant presentation of meningitis look like?

A
  • Poor feeding, vomiting
  • Temperature instabilities
  • Seizures
  • Bulging fontanelle
  • Lethargy, irritability
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8
Q

What are ADDITIONAL s/s that may be seen in children with meningitis?

A
  • Photophobia
  • Stiff neck
  • Headache
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9
Q

What is the gold standard for bacterial meningitis diagnosis?

A

CSF positive culture from lumbar puncture

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10
Q

What are CSF findings of BACTERIAL meningitis?

A
  • Low glucose
  • High protein
  • High WBC
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11
Q

What are CSF findings of VIRAL meningitis?

A
  • Normal glucose
  • Low to normal protein
  • High WBC but not as high as bacterial
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12
Q

How should bacterial meningitis be treated in neonates?

A

Ampicillin + AG
or
Ampicillin + cefotaxime (if renal issues)

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13
Q

What additional drug should be used for empiric therapy in neonatal meningitis if HSV is suspected?

A

Acyclovir

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14
Q

How should bacterial meningitis be treated in ages 1 and up?

A

Vancomycin + cefotaxime
or
Vancomycin + ceftriaxone

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15
Q

Which drug causes hyperbilirubinemia and should be avoided in neonates?

A

Ceftriaxone

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16
Q

What is the AUC/MIC target for vancomycin in pediatrics?

A

400-600 AUC/MIC

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17
Q

What are the ADEs to look out for with vancomycin?

A

Nephrotoxicity, infusion reactions, ototoxicity

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18
Q

If used, when should dexamethasone be administered?

A

10-20 min before or with the 1st dose of antibiotics

No benefit after 1 hour of antibiotics

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19
Q

How might dexamethasone be helpful in children and infants >6 weeks with bacterial meningitis?

A

To decrease hearing loss in patients with H. influenza meningitis (NOT NEONATES)

20
Q

What are IDSA indications for dexamethasone in the setting of pediatric meningitis?

A
  • H. influenzae suspected, before antibiotics
  • Consider if s. pneumoniae and high risk of mortality
21
Q

What is the most common comorbidity that leads to CAP?

A

Asthma

22
Q

What are the 3 routes of entry for pathogens causing CAP?

A
  • Inhaled aerosolized particles
  • Through bloodstream
  • Aspiration
23
Q

What are the hallmark s/s of CAP that must be present for diagnosis?

A
  • Fever
  • Cough
24
Q

What is the gold standard for bacterial CAP diagnosis?

A

Chest X-ray lobar or confuse consolidation in one lobe of the lung

25
Q

How does a viral CAP infection look on a chest X-ray?

A

General haziness throughout both lungs

26
Q

What diagnostics are rarely drawn/used for CAP?

A
  • Blood cultures
  • Sputum cultures
27
Q

Who should be hospitalized for CAP?

A
  • 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
28
Q

What is the best predictor of pathogen identification in CAP?

A

AGE

29
Q

What is the most common pathogen for CAP across all age groups up to 15?

A

S. pneumoniae

30
Q

T/F: Viruses such as RSV are significant causes of CAP in young children and infants.

A

TRUE

31
Q

When do atypical bacteria begin to enter the suspected pathogen pool and become more common for CAP? (M. pneumoniae, C. pneumoniae)

A

5 years of age

32
Q

When should CAP symptoms resolve with appropriate treatment?

A

2-3 days

33
Q

What are the 1st and 2nd line treatments for outpatient bacterial CAP outpatient?

A
  1. Amoxicillin PO 90 mg/kg/day in 2 doses
  2. Augmentin PO 90 mg/kg/day in 2 doses
34
Q

What is the first line treatment for presumed atypical CAP outpatient?

A

Azithromycin PO 10 mg/kg on day 1, followed by 5 mg/kg on days 2-5

35
Q

T/F: Azithromycin and penicillins should not be used together to treat CAP.

A

FALSE: Azithromycin can be added on to the first line treatment if bacterial vs. atypical is ambiguous

36
Q

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)

A

Ampicillin IV* or penicillin G IV

37
Q

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)

A

Ceftriaxone IV* or cefotaxime IV

38
Q

Why do we use high dose amoxicillin/augmentin to treat CAP?

A

To overcome s. pneumoniae mechanism of resistance - penicillin-binding proteins

39
Q

What does the clavulanate offer in augmentin?

A

Coverage of B-lactamase producing organisms (H. influenzae)

40
Q

Why is the ES formulation preferred for high-dose augmentin/amoxicillin?

A

To minimize supratherapeutic concentrations of clavulanate

41
Q

Why does azithromycin have such a short treatment course?

A

Its long half life produces a post-antibiotic effect

42
Q

Why is ceftriaxone used in un-immunized children?

A

Concern for H. influenzae (B-lactamase-producing)

43
Q

What is the viral influenza treatment that should be used within 48 hours of symptoms to be effective?

A

Oseltamivir - 5 day course

44
Q

What is the IDSA recommended treatment duration for CAP?

A

10 days

45
Q

What should you switch to if a patient has a non-serious penicillin allergy?

A

Trial under medical supervision:
- Cephalosporins such as cefpodoxime, cefprozil, cefuroxime

46
Q

What should you switch to if a patient has a history of anaphylaxis to penicillin?

A
  • Levofloxacin
  • Linezolid
  • Macrolide
  • Clindamycin
  • Bactrim

704 Pediatrics (6 decks)

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