Meningitis Flashcards
Common organisms for <1mo meningitis
S. agalactiae
Listeria monocytogenes
Strep pneumo
Neisseria meningitidis
Common organisms for 1-23 mo meningitis
S. pneumo
Neisseria meningitidis
H. influenzae
S. agalactiae
Common organisms for 2-50 y/o meningitis
N. meningitidis
S. pneumo
Common organisms for >50 y/o meningitis
S. pneumo
N. meningitidis
L. monocytogenes
N. meningitidis meningitis common symptom
Petechiae or purpura
Physical signs of meningitis
Brudzinski sign (involuntary flexion of hips/knees when neck flexed)
Kernig sign (pain or resistance when leg moved from 90 degree to 135 degree)
Bulging fontanel (infants)
Bacterial meningitis CSF culture
Glucose: <50 (<=0.4 CSF:blood)
Protein: >150
WBC: >1000-5000 (neutrophils)
pH:: 7.1
Lactic acid: >35
Viral meningitis CSF culture
Glucose: normal (30-70; 2/3 peripheral)
Protein: normal-slightly elevated (<50 is normal)
WBC: 5-300 (lymphocytes)
pH: normal (7.3)
lactic acid: normal (<14)
C reactive protein in meningitis
High negative predictive value (if negative, unlikely meningitis)
Empiric meningitis therapy for neonate
Ampicillin + aminoglycoside
OR
ampicillin + cefotaxime
Empiric meningitis therapy for 1-23 mo/old
Ceftriaxone + vancomycin
Empiric meningitis therapy for 2-50 y/o
Ceftriaxone + vancomycin
Empiric meningitis therapy for >50 y/o
Ceftriaxone + vancomycin + ampicillin
Empiric meningitis therapy if head trauma, neurosurgery, or CSF shunt
Vanco + cefepime, ceftazidime, or meropenem
Vancomycin purpose in empiric meningitis therapy
Activity against highly resistant S. pneumoniae
S. pneumoniae meningitis therapy if MIC to PCN <=0.1
Penicillin G 4 million units q4h
Ampicillin 2gm q4h
alt: ceftriaxone 2gm q12h
alt: chloramphenicol 1-1.5g q6h
S. pneumoniae meningitis therapy if MIC to PCN 0.1-1.0
ceftriaxone
alt: cefepime 2gm q8h
alt: meropenem 2gm q8h
S. pneumoniae meningitis therapy if MIC >=2.0
Vancomycin + ceftriaxone
alt: moxifloxacin 400 q24
Cephalosporin resistant: add rifampin; linezolid; vanc + moxifloxacin
N. meningitidis meningitis therapy if MIC to PCN <0.1
Pen G
Ampicillin
Alt: 3rd gen cephalosporin
Alt: chloramphenicol
N. meningitidis meningitis therapy if MIC to PCN 0.1-1.0
Ceftriaxone
Alt: chloramphenicol
Alt: FQ
Alt: meropenem
H. influenzae meningitis therapy if B lactamase negative
Ampicillin
Alt: 3rd gen cephalosporin
Alt: cefepime
Alt: chloramphenicol
Alt: FQ
H. influenzae meningitis therapy if B lactamase positive
3rd gen cephalosporin
Alt: cefepime
Alt: chloramphenicol
Alt: FQ
S. agalactiae meningitis therapy
Penicillin G
Ampicillin
Alt: Bactrim 5mg/kg q6-12h
Alt: meropenem
HSV meningitis therapy
Acyclovir 10mg/kg/dose over 1 hour every 8 hours
Alt: cidofovir
Alt: foscarnet
Meningitis duration of treament
7 days (N. meningitidis, H. influenzae)
10-14 days (S. pneumo, HSV)
14-21 days (S. agalactiae)
> =21 days (L. monocytogenes)
Dexamethasone for meningitis
0.15mg/kg or 10mg q6h x2-4 days
Start 10-20 min before or with first dose of ABX
children: H. flu, prevents hearing loss
adults: S. pneumo, reduces mortality
Chemoprophylaxis for N. meningitidis meningitis
Close contacts and exposure to oral secretions:
RIFAMPIN Q12H X4 DOSES
Adults: 600mg
Children: 10 mg/kg
Neonates: 5mg/kg
OR
Adults: cipro 500mg PO once
OR
Ceftriaxone 125-250mg IM once
Chemoprophylaxis for H. influenzae meningitis
Close contacts with unvaccinated or immunocompromised children
RIFAMPIN DAILY FOR 4 DAYS
Adults: 600mg daily
Children (<12 y/o): 20mg/kg/day
Neonates: 10mg/kg/day
Brain abscess
Generally cover for streptococcus and anaerobes
