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Spring 15 - Pharm Unit II > Meningitis > Flashcards

Meningitis Flashcards

1
Q

Meningitis

A

inflammation/infection of the membranes surrounding the brain and spinal cord

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2
Q

S. pneumo Morphology

A

Gm+ cocci (pairs or chains)

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3
Q

H. flu Morphology

A

Gm- coccobacilli

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4
Q

N. meningitidis Morphology

A

Gm- cocci

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5
Q

Gram - Bacteria (E coli, Klebsiella, Pseudomonas) Morphology

A

Gm- bacilli

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6
Q

Listeria monocytogenes Morphology

A

Gm+ bacilli

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7
Q

Meningitis Risk Factors

A
  • anything that decreases immune function (sickle cell anemia, asplenic, HIV, DM, URI, otitis media)
  • penetrating trauma or surgery near the brain (cochlear implants, head trauma)
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8
Q

Meningitis Sequelae

A
  • sensorineural hearing loss
  • hydrocephalus
  • focal sensory motor deficits
  • seizure disorder
  • death 2-30% (20% average)
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9
Q

Intrathecal Route

A

meds delivered to spinal cord

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10
Q

Intraventricular Route

A

meds delivered directly to ventricles

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11
Q

Factors that Increase Penetration of Abx into CSF

A
  • meningeal inflammation
  • low molecular weight med
  • lipid soluble med
  • compounds that remain un-ionized at physiologic pH
  • low protein bound meds
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12
Q

What meds can reach therapeutic levels in CSF +/- inflammation?

A
  • TMP/sulfonamides
  • chloramphenicol
  • rifampin
  • metronidazole
  • isoniazid, pyrazinamide, ethionamide (TB drugs)
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13
Q

What meds can reach therapeutic levels in CSF with meningeal inflammation?

A
  • most beta lactams (but not 1st/2nd gen cephs)
  • penicillin, nafcillin
  • cephalosporins
  • imipenem
  • vancomycin
  • fluconazole
  • acyclovir
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14
Q

What meds cannot reach therapeutic levels in CSF?

A
  • aminoglycosides
  • 1st and 2nd gen cephalosporins (except cefuroxime)
  • clindamycin
  • amphotericin
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15
Q

Pathophysiologic Responses of Meningitis

A
  • increased ICP
  • decreased cerebral blood flow
  • ischemic and direct tissue damage
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16
Q

CSF Findings for Meningitis

A
  • very high WBC (1000-5000)
  • high neutrophils (>80)
  • high protein (100-500)
  • low glucose (<40)
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17
Q

Likely Meningitis Pathogens for Age: <1 month

A
  • Group B strep
  • E coli
  • Listeria
  • Klebsiella
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18
Q

Likely Meningitis Pathogens for Age: 1-23 months

A
  • S. pneumo
  • N. mening
  • Group B strep
  • H. flu
  • E. coli
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19
Q

Likely Meningitis Pathogens for Age: age 2-50

A
  • S. pneumo

- N. mening

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20
Q

Likely Meningitis Pathogens for Age: > 50

A
  • S. pneumo
  • N. mening
  • Listeria
  • gram negative bacilli
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21
Q

Meningitis Tx Goals

A
  • eradicate infection
  • improve signs and sxs
  • prevent development of neurologic sequelae
22
Q

Treatment of Bacterial Meningitis

A
  • always dexamethasone and empiric therapy

- switch to targeted abx therapy once there is a positive CSF gram stain

23
Q

Negative/Unavailable Gram Stain: Empiric Tx for <1 Month Pts

A

ampicillin + cefotaxime

or ampicillin + aminoglycoside

24
Q

Negative/Unavailable Gram Stain: Empiric Tx for 1-23 Month Pts

A

vancomycin + third gen ceph

25
Negative/Unavailable Gram Stain: Empiric Tx for Age 2-50 Pts
vancomycin + third gen ceph
26
Negative/Unavailable Gram Stain: Empiric Tx for >50 Years Pts
vancomycin + ampicillin + third gen ceph
27
Positive CSF Gram Stain Empiric Therapy: Gram+ diplococci
ceftriaxone or cefotaxime + vanco + dexamethasone
28
Positive CSF Gram Stain Empiric Therapy: Gram- diplococci
ceftriaxone or cefotaxime
29
Positive CSF Gram Stain Empiric Therapy: Gram+ bacilli
ampicillin +/- gentamicin
30
Positive CSF Gram Stain Empiric Therapy: Gram- bacilli
ceftazadime or cefepime +/- gentamicin
31
Targeted Therapy for Group B Strep
penicillin G or ampicillin
32
Targeted Therapy for H. flu
ceftriaxone
33
Targeted Therapy for N. meningitidis
ceftriaxone
34
Targeted Therapy for Listeria monocytogenes
ampicillin +/- gentamicin
35
Targeted Therapy for S. pneumo Pen MIC <0.1
penicillin G or ampicillin
36
Targeted Therapy for S. pneumo Pen MIC .01-1
ceftriaxone or cefotaxime
37
Targeted Therapy for S. pneumo Pen MIC 2+
vanco + ceftriaxone/cefotaxime
38
Targeted Therapy for S. pneumo Ceftriaxone MIC 1+
vanco + ceftriaxone/cefotaxime
39
Why is dexamethasone sometimes used?
-attenuation of inflammatory response may diminish many pathophys consequences of meningitis (eg cerebral edema, increased ICP)
40
In what meningitis pts should dexamethasone be used as an adjunct?
- infants and kids with H. flu B (only if started before abx) - adults with pneumococcal meningitis (only if started before abx)
41
Dexamethasone Dose
0.15 mg/kg q6 hours for 2-4 days 5 minutes before or with first antimicrobial dose
42
Who should receive meningitis prophylaxis?
-close contacts of pts with H. flu or N. meningitidis
43
Prophylaxis Dose for H. flu B Meningitis
rifampin 600 mg PO q24h x4 days
44
Prophylaxis Dose for N. mening Meningitis
- ceftriaxone 250 mg IM x1 - rifampin 600 mg PO q12h x4 doses - cipro 500 mg PO x1 (but not in MN d/t resistance)
45
Etiology of Viral Encephalitis
- arboviruses: St. Louis, La Crosse, West Nile - Herpes viruses: HSV, Varicella zoster, Epstein Barr - enteroviruses
46
Clinical Presentation of Encephalitis
- altered mental status - altered behavior and personality changes - motor or sensory deficits - speech or movement disorders - seizures
47
Treatment of All Viral Encephalitis Pathogens
supportive: fluids, antipyretics, analgesics
48
Treatment of West Nile Virus
- supportive care - anti-seizure meds if needed - tx for increased ICP if needed
49
Treatment of HSV Encephalitis
- supportive care - anti-seizure meds - acyclovir: 10 mg/kg IV q8 hours x2-3 weeks (maintain hydration to prevent acute kidney injury)
50
Ceftriaxone CNS Dosing
2 grams IV q12-24 hours
51
Vancomycin CNS Dosing
15 mg/kg IV q8-12 hours
52
Because CNS infxs are more serious, what type of dosing do we use? How does the dosing level compare to the level used for other types of infxs?
- maximized abx dose to optimize CNS penetration | - shooting for 10-30x MIC when treating CNS infxs (2-4x MIC in other infxs)

Spring 15 - Pharm Unit II (9 decks)

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