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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
Q

Negative/Unavailable Gram Stain: Empiric Tx for Age 2-50 Pts

A

vancomycin + third gen ceph

26
Q

Negative/Unavailable Gram Stain: Empiric Tx for >50 Years Pts

A

vancomycin + ampicillin + third gen ceph

27
Q

Positive CSF Gram Stain Empiric Therapy: Gram+ diplococci

A

ceftriaxone or cefotaxime + vanco + dexamethasone

28
Q

Positive CSF Gram Stain Empiric Therapy: Gram- diplococci

A

ceftriaxone or cefotaxime

29
Q

Positive CSF Gram Stain Empiric Therapy: Gram+ bacilli

A

ampicillin +/- gentamicin

30
Q

Positive CSF Gram Stain Empiric Therapy: Gram- bacilli

A

ceftazadime or cefepime +/- gentamicin

31
Q

Targeted Therapy for Group B Strep

A

penicillin G or ampicillin

32
Q

Targeted Therapy for H. flu

A

ceftriaxone

33
Q

Targeted Therapy for N. meningitidis

A

ceftriaxone

34
Q

Targeted Therapy for Listeria monocytogenes

A

ampicillin +/- gentamicin

35
Q

Targeted Therapy for S. pneumo Pen MIC <0.1

A

penicillin G or ampicillin

36
Q

Targeted Therapy for S. pneumo Pen MIC .01-1

A

ceftriaxone or cefotaxime

37
Q

Targeted Therapy for S. pneumo Pen MIC 2+

A

vanco + ceftriaxone/cefotaxime

38
Q

Targeted Therapy for S. pneumo Ceftriaxone MIC 1+

A

vanco + ceftriaxone/cefotaxime

39
Q

Why is dexamethasone sometimes used?

A

-attenuation of inflammatory response may diminish many pathophys consequences of meningitis (eg cerebral edema, increased ICP)

40
Q

In what meningitis pts should dexamethasone be used as an adjunct?

A
  • infants and kids with H. flu B (only if started before abx)
  • adults with pneumococcal meningitis (only if started before abx)
41
Q

Dexamethasone Dose

A

0.15 mg/kg q6 hours for 2-4 days 5 minutes before or with first antimicrobial dose

42
Q

Who should receive meningitis prophylaxis?

A

-close contacts of pts with H. flu or N. meningitidis

43
Q

Prophylaxis Dose for H. flu B Meningitis

A

rifampin 600 mg PO q24h x4 days

44
Q

Prophylaxis Dose for N. mening Meningitis

A
  • 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
Q

Etiology of Viral Encephalitis

A
  • arboviruses: St. Louis, La Crosse, West Nile
  • Herpes viruses: HSV, Varicella zoster, Epstein Barr
  • enteroviruses
46
Q

Clinical Presentation of Encephalitis

A
  • altered mental status
  • altered behavior and personality changes
  • motor or sensory deficits
  • speech or movement disorders
  • seizures
47
Q

Treatment of All Viral Encephalitis Pathogens

A

supportive: fluids, antipyretics, analgesics

48
Q

Treatment of West Nile Virus

A
  • supportive care
  • anti-seizure meds if needed
  • tx for increased ICP if needed
49
Q

Treatment of HSV Encephalitis

A
  • supportive care
  • anti-seizure meds
  • acyclovir: 10 mg/kg IV q8 hours x2-3 weeks (maintain hydration to prevent acute kidney injury)
50
Q

Ceftriaxone CNS Dosing

A

2 grams IV q12-24 hours

51
Q

Vancomycin CNS Dosing

A

15 mg/kg IV q8-12 hours

52
Q

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?

A
  • 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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