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Antibiotics > Meningitis > Flashcards

Meningitis Flashcards

1
Q

Which abx targets Listeria monocytogenes?

A

Ampicillin, amoxicillin, penicilin

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2
Q

When is lumbar puncture contraindicated?

A

Increased intracranial pressure, brain shift, infection at lumbar puncture site, rapidly spreading purpura

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3
Q

What are the causes of meningitis?

A

Infection (bacteria, virus e.g. enterovirus, herpes; fungal), drugs (co-trimoxazole), autoimmune disease

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4
Q

Symptoms of meningitis?

A

HA, backache, neck stiffness, mental status changes, photophobia

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5
Q

What special symptom is characteristic of Neisseria meningitidis meningitis?

A

Purpura or petechiae

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6
Q

What are physical signs of meningitis?

A

Kerning sign, Brudzinki sign, bulging fontane (infants)

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7
Q

Difference between normal, bacterial and viral CSF? (turbidity, WBC, protein, glucose)

A

Normal: clear, <5 WBC/mm3, protein <0.4g/L, CSF:blood glucose >0.66

Bacterial: turbid, raised WBC >100/mm3 (mainly neutrophils), raised protein >1.5g/L, CSF:blood glucose <0.4 (very low glucose)

Viral: clear, raised WBC >1000/mm3 (mainly lymphocytes), normal to slightly raised protein, normal to slightly low glucose

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8
Q

What are the most likely bacteria to cause meningitis in neonates (<1m)?

A

Group B strep (strep agalactiae), E coli, Listeria monocytogenes

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9
Q

What are the most likely bacteria to cause meningitis in infants and children (1-23m)?

A

S pneumo, N meningitidis, grp B strep (strep agalactiae), E coli, H influenzae

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10
Q

What are the most likely bacteria to cause meningitis in children and adults (2-50y)?

A

S pneumo, N meningitidis

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11
Q

What are the most likely bacteria to cause meningitis in adults (>50y)?

A

S pneumo, N meningitidis, L monocytogenes, aerobic gram -ve (E coli, Klebsiella)

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12
Q

Where is Listeria monocytogenes usually found?

A

Moist env, soil, water, foods (even in fridge like cold deli meats, unpasteurised dairy products)

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13
Q

When to start empiric abx for meningitis?

A

Within 1h

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14
Q

Empiric treatment for meningitis in neonates?

A

Ceftriaxone + ampicillin (listeria)
(ceftriaxone can only be used for PMA≥41w or <28d & no hyperbilirubinemia)

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15
Q

Empiric treatment for meningitis in children and adults (1m-50y)?

A

Ceftriaxone + vancomycin (for penicillin & cephalosporin resistant species)

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16
Q

Empiric treatment for meningitis in adults (>50y)?

A

Ceftriaxone + vancomycin (for penicillin & cephalosporin resistant species) + ampicillin (listeria)

17
Q

Treatment for Strep pneumo meningitis and duration?

A
  • Penicillin susceptible: penicillin G / ampicillin
  • Penicillin resistant, cephalosporin susceptible: ceftriaxone
  • Penicillin & cephalosporin resistant: vancomycin + rifampicin
  • Duration: 10-14 days
18
Q

Treatment for Neisseria meningitidis meningitis and duration?

A
  • Penicillin susceptible: penicillin / ampicillin
  • Penicillin resistant or mild allergy: ceftriaxone
  • Duration: 5-7 days
19
Q

Treatment for Listeria monocytogenes meningitis and duration?

A
  • Penicillin G or ampicillin
  • Penicillin allergy: co-trimoxazole, meropenem
  • Duration: ≥21 days
20
Q

Treatment for Grp B strep (strep agalactiae) meningitis and duration?

A
  • Penicillin or ampicillin
  • Penicillin resistant or allergy: ceftriaxone
  • Duration: 14-21 days
21
Q

Should PO or IV antibiotics be used for meningitis?

A

IV

22
Q

How long should empiric treatment be if cultures come back negative?

A

14 days (10 days on NICE)

23
Q

What age can dexamethasone be used as adjunct?

A

3 months

24
Q

Which bacteria can dexamethasone be used for and why?

A

H influenzae (less hearing loss), S pneumo (less hearing loss & mortality)

25
Q

What are the risks of using dexamethasone?

A

Less abx penetration (inflammation makes the BBB more leaky)

26
Q

Dose of dexamethasone and when to adm?

A

10mg (0.15mg/kg) Q6h for up to 4 days, adm the 10-20min before or at the same time as the first dose of abx

27
Q

Treatment of H influenzae meningitis and duration?

A

Ceftriaxone, 7 days

28
Q

Chemoprophylaxis for Neisseria meningitis? and number of doses

A
  • PO Rifampicin (adult: 600mg BD; children: 10mg/kg BD; neonates: 5mg/kg BD), 4 doses
  • PO ciprofloxacin (adult: 500mg), 1 dose
  • IM ceftriaxone (125-250mg), one dose
29
Q

What to use for empiric treatment of meningoencephalitis?

A

Acyclovir, ceftriaxone (+vancomycin) (+ampicillin for listeria)

30
Q

Can use PO or IV acyclovir for encephalitis?

A

IV, poor oral bioavailability

31
Q

How long to treat encephalitis?

A

14-21 days

Antibiotics (11 decks)

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