Meningitis Flashcards
LOWER PRIORITY
Meningitis is the
inflammation of the meninges
The most common pathogens that cause bacterial meningitis are
1
2
3
1 S. pneumoniae
2 H. influenzae
3 N. meningitides
The most common cause of meningitis is through _________ spread
hematogenous (via blood stream)
Contiguous spread (sinusitis, otitis media)
and direct bacterial inoculation (head trauma, neurosurgery) are less common
Group B streptococci, _____________, _____________ are significant causes of meningitis in neonates, immunocompromised, and older adults
E. coli
Listeria monocytogenes
What are the 3 cardinal symptoms of meningitis
1
2
3
Stiff neck
Fever
Altered mental status
One of the main risk factors associated with bacterial meningitis:
extremes of age
additionally:
- head trauma
- exposure to known meningitis patient
- IMMUNOCOMPROMISED
Examination of the ___ is essential for making the diagnosis and is warranted whenever meningitis is suspected
CSF
Delay empiric antibacterial therapy if a lumbar puncture (LP) cannot be performed at the time of presentation
True or False
FALSE - NEVER DELAY !!
Complications of bacterial meningitis include
1
2
3
1 death
2 neurological sequelae
3 inappropriate secretion of ADH (hyponatremeia and worsening cerebral edema)
Immediately start empiric IV antibiotics + __________ after lumbar puncture is done or if delayed lumbar puncture for meningitis treatment
dexamethasone
Meningitis:
When administering vancomycin in combination with a third-generation cephalosporin, give the ___________ followed 2 hours later by __________
cephalosporin followed 2 hours later by vancomycin, giving the cephalosporin first ensures initial broad coverage and penetration into the CSF
Most likely organisms for meningitis in Neonates <1 month are
1
2
3
1 GROUP B STREP
2 E COLI
3 LISTERIA
other gram negatives
Most likely organisms for meningitis in infants and children >1 month - 2 yrs
1
2
3
4
1 E coli
2 S pneumo
3 N menin
4 H influ
Most likely organisms for meningitis in older children and adults 2-50 years old
1
2
3
S pneumo
H influ
N menin
Most likely organisms for meningitis in >50 and those with risk factors such as alcoholism, altered immune status
1
2
3
4
S pneumo
N menin
Listeria
E coli
What two organisms in meningitis of the elderly/immunocompromised and very young are most common?
1
2
E coli
Listeria
Empiric Drug Therapy (Meningitis)
Neonates <1 months
1.
2.
- Ampicillin + cefotaxime
- Ampicillin + aminioglycosides (gentamicin)
Ampicillin will cover Strep, Listeria
additions cover gram negative
In the treatment of meningitis of neonates, this drug cannot be used as it can cause SLUDGING
Ceftriaxone
In all individuals >1 month - 50 years of age with presumed meningitis, use __________ or __________ followed ≥2 hours later by vancomycin as empiric therapy. This will provide coverage for penicillin-susceptible and -resistant S. pneumoniae, N. meningitidis and H. influenzae
Cefotaxime + vancomycin
Ceftriaxone + vancomycin
(ampicillin if immunocompromised)
Vancomycin covers drug resistant S. pneumo
Beta lactam allergy?
Meropenem (S.pneumo, H.influ, N.menin) + Vanco (add tmp- smx if immunocompromised)
Patients > 50 or with risk factors such as alcoholism, immunosuppression should use
________ + _________ + _________ for empiric treatment of meningitis
Ampicillin (to provide coverage for listeria) + 3rd gen cephalosporin + Vancomycin
Beta lactam allergy?
TMP-SMX (listeria) + meropenem + vancomycin
TMP-SMX + moxifloxacin + vancomycin
______________ can be used in patients with meningitis who have blood or CSF isolates of S. pneumoniae
Penicillin G or 3rd gen cephalosporin +/- vanco x 10-14 days
Meningitis:
_______________, a broad spectrum fluoroquinolone, may be an option (if the isolate is susceptible) in the rare event of resistance to ceftriaxone, cefotaxime and meropenem, or true anaphylaxis
Moxifloxacin
Meningitis:
____________ is thought to increase the risk of seizures more than meropenem
Meropenem
______________ can be used in patients with meningitis who have blood or CSF isolates of N. meningitidis
Pen G or 3rd gen ceph x 7 days
______________ can be used in patients with meningitis who have blood or CSF isolates of Group B strep/ Listeria
Pen G or ampicillin + gentamicin for synergy x 14 -21 days
______________ can be used in patients with meningitis who have blood or CSF isolates of H. Influenzae beta lactamase negative
IV ampicillin x 7-10 days
______________ can be used in patients with meningitis who have blood or CSF isolates of H. Influenzae beta lactamase positive
3rd gen cephalosporin x 7-10 days
Adjunctive __________ in meningitis (S. pneumoniae/ H. influenzae) helps reduce cerebral edema, lower intracranial pressure and prevent hearing loss and short term neurological sequalae
DEXAMETHASONE
Consider the addition of _______ to vancomycin for suspected S. pneumo resistance to 3rd gen cephalosporin meningitis
Rifampin
In certain individuals ie. close contact individuals, meningitis prophylaxis should be offered with exposure to these two pathogens
1
2
N. meningitidis
H influenzae
Meningitis prophylaxis treatment:
1. Exposure to N. meningitidis
______ or ______ or ______ (in pregnant patients)
- Exposure to H. influenzae
______ or ______ (in pregnant patients)
- rifampin or cipro or ceftriaxone
- rifampin or ceftriaxone
