Meningitis

Question 1

Most common cause of meningitis in the US

Answer 1

streptococcus pneumoniae

Question 2

empiric therapy for a child under 1 month

Answer 2

ampicillin + cefotaxime or gentamicin

Question 3

empiric therapy for ages 1 month-50 years

Answer 3

cefotaxime or ceftriaxone + vancomycin (+dexamethasone)

Question 4

empiric therapy for people over 50 years or alcoholics

Answer 4

ampicillin + ceftriaxone or cefotaxime + vancomycin (+dexamethasone)

Question 5

when do you add ampicillin?

Answer 5

when you suspect Listeria

Question 6

this is an anti-inflammatory drug that needs to be administered before antibiotics, improves CNS parameters, and does not effect penetration of vancomycin

Answer 6

dexamethasone

Question 7

this drug can decrease hearing loss that can occur with administration of vancomycin

Answer 7

dexamethasone

Question 8

do not give this drug to patients with meningitis and septic shock

Answer 8

dexamethasone

Question 9

Expect infection with this gram negative diplococci in children and young adults, in winter and spring. It can cause pts to have behavioral changes, seizures, coma, DIC, purpuric lesions

Answer 9

N. meningitidis

Question 10

Drug of choice for treatment of N. meningitidis meningitis

Answer 10

high dose IV PCN G

alternatives include cefotaxime, ceftriaxone, and chloramphenicol

Question 11

prophylaxis regimen for N. meningitidis

Answer 11

Rifampin (adults and children)

Ceftriaxone (pregnancy)

Question 12

Expect infection with this gram positive diplococci commonly in adults and children. Especially in pts with pneumonia, endocarditis, splenectomy, head trauma, alcoholism, sickle cell disease, and bone marrow transplant

Answer 12

S. pneumoniae

Question 13

Treatment of S pneumoniae meningitis

Answer 13

Cefotaxime
Ceftriaxone
in PCN susceptible, switch to PCN
switch to vanco if resistant to beta lactams

Question 14

Expect infection with this gram negative bacilli if a patient shows up with morbiliform or petechial rash (rare)

Answer 14

H. influenzae

Question 15

treatment of h influenzae meningitis

Answer 15

ceftriaxone or cefotaxime

Question 16

Prophylaxis for H influenzae

Answer 16

Rifampin (unless fully vaccinated and over 2 years)

Question 17

Expect infection with this gram positive bacilli in neonates, immunocompromised adults, and the elderly. Common in the summer and early fall

Answer 17

Listeria

Question 18

DOC for treatment of listeria

Answer 18

IV ampicillin (or PCN) plus an aminoglycoside 
can use TMP/SMX if allergic

Question 19

Expect infection with this type of bacteria infrequently. Risk factors include cranial trauma, neurosurgery, immunosuppression, hospitalization, and elderly.

Answer 19

gram negative bacilli (e coli, klebsiella, pseudomonas)

Question 20

treatment for pseudomonas

Answer 20

IV ceftazidime plus gentamicin

Question 21

treatment for e coli or klebsiella

Answer 21

3rd generation cephalosporins