Meningitis

Question 1

Risk factors for meningitis

Answer 1

Age (young children and elderly), alcohol use, DM, immunosuppression, head trauma/surgery, congenital defects

Question 2

Classic triad of meningitis

Answer 2

Fever, change in mental status, neck rigidity

Question 3

Meningitis symptoms

Answer 3

Hearing loss or vestibular function, brain edema, vascular alterations, hydrocephalus, altered mental status and level of consciousness

Question 4

Meningitis diagnosis methods

Answer 4

Lumbar puncture, blood cultures, head CT or MRI

Question 5

Predominant WBC in bacterial meningitis

Answer 5

Neutrophils

Question 6

Pathogens that cause meningitis in 2-50 years old

Answer 6

S. pneumoniae, N. meningitidis

Question 7

Pathogens that cause meningitis in >50 years old

Answer 7

S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gram-negative bacilli

Question 8

ABX with good BBB penetration

Answer 8

Fluoroquinolones, linezolid

Question 9

ABX with penetration with inflammation

Answer 9

Ampicillin, ceftriaxone, vanco

Question 10

ABX therapy considerations for meningitis

Answer 10

Obtain gram stain, CSF, and blood cultures prior to first dose of ABX and initiate ABX ASAP based on patient factors even before a lumbar puncture is performed. Adjust the treatment according to cultures of susceptibilities

Question 11

Empiric tx of meningitis for ages 2-50

Answer 11

Vanco and 3rd generation cephalosporin

Question 12

Empiric tx of meningitis for age >50

Answer 12

Vanco, 3rd gen cephalosporin, ampicillin

Question 13

Empiric tx of meningitis due to basilar skull fracture

Answer 13

Vanco and 3rd generation cephalosporin

Question 14

Empiric tx of meningitis due to penetrating trauma, post-neurosurgery, CSF shunt

Answer 14

Vanco with cefepime, ceftazidime, or meropenem

Question 15

Definitive therapy for meningitis caused by S. pneumoniae with a PCN MIC of <0.1mcg/ml

Answer 15

Pen G, ampicillin

Question 16

Definitive therapy for meningitis caused by S. pneumoniae with a PCN MIC of 0.1-1.0mcg/ml

Answer 16

3rd generation cephalosporin

Question 17

Definitive therapy for meningitis caused by S. pneumoniae with a PCN MIC of ≥2.0mcg/ml

Answer 17

Vanco and 3rd gen cephalosporin

Question 18

Duration of treatment for S. pneumoniae meningitis

Answer 18

10-14 days

Question 19

Definitive therapy for meningitis caused by H. influenzae that’s beta-lactamase positive

Answer 19

Third generation cephalosporin

Question 20

Definitive therapy for meningitis caused by H. influenzae that’s beta-lactamase negative

Answer 20

ampicillin

Question 21

Duration of treatment for H. influenzae meningitis

Answer 21

7 days

Question 22

Definitive therapy for meningitis caused by L. monocytogenes

Answer 22

Ampicillin or Pen G

Question 23

Duration of treatment for L. monocytogenes meningitis

Answer 23

≥21 days

Question 24

Route of administration of meningitis treatment

Answer 24

Intraventricular or intrathecal

Question 25

Meningitis supportive care

Answer 25

Fluids, electrolytes, antipyretics, analgesics, respiratory and circulatory support

Question 26

Dexamethasone for infants and children with H. influenzae meningitis (dosing)

Answer 26

0.15mg/kg q6h x2-4 days administered before 1st ABX dose

Question 27

Dexamethasone for adults with pneumococcal meningitis (dosing)

Answer 27

0.15mg/kg (max 10mg) x2-4 days administered before 1st ABX dose