Meningitis Flashcards
What are the most common pathogens in infants 1 to 23 months?
Strep. agalactiae E. coli Haemophilus influenzae Strep. pneumoniae Neisseria meningitidis
What are the most common pathogens in those 2 to 50 years old?
Strep. pneumoniae
Neisseria meningitidis
What are the most common pathogens in those over 50 years old?
Strep. pneumoniae
Neisseria meningitidis
Listeria monocytogenes
Aerobic gram (-) bacilli
What are the most common pathogens in infants less than 1 month?
Strep. agalactiae
E. coli
Listeria monocytogenes
Klebsiella pneumoniae
What drugs are effected MAXIMALLY and MINIMALLY by steroids
Maximal Effect: vancomycin and beta-lactams
Minimal effect: rifampin and fluoroquinolones
What is meningitis?
Inflammation of the MEMBRANE of the brain, spinal cord, and cerebral spinal fluid
NOT inflammation of the brain itself
What are risk factors for meningitis?
Extreme ages (very young and very old) Immune defects Close living conditions Cig smoke exposure Respiratory infection
What are the differences in WBC levels?
Normal: 5
Bacterial: 1000-5000
Viral: 100-1000
What are the differences in WBC differentials?
Normal: >/= 85% monocytes
Bacterial: >/= 80% PMNs
Viral: 50% lymphocytes
What are the differences in CSF:serum glucose ratios?
Normal: >/= 0.6
Bacterial: = 0.4
Viral: >/= 0.6
What is the empiric treatment for those under 1 month?
Amp + cefotaxime
or
Amp + AG
What is the empiric treatment for those 1 to 23 months?
Vancomycin + cefotaxime/ceftriaxone
What is the empiric treatment for those 2 to 50 years old?
Vancomycin + cefotaxime/ceftriaxone
What is the empiric treatment for those over 50 years?
Vancomycin + Amp + Cefotaxime/Ceftriaxone
Drug of choice for S. pneumoniae with a PCN MIC
Ampicillin
10-14 days
Drug of choice for S. pneumoniae with a PCN MIC 0.1 to 1.0
Ceftriaxone or Cefotaxime
10-14 days
Drug of choice for S. pneumoniae with a PCN MIC >/= 2.0
Vancomycin + Ceftriaxone/cefotaxime
10-14 days
Drug of choice for S. pneumoniae with a Cephamycin MIC >/= 1.0
Vancomycin + Ceftriaxone/cefotaxime
10-14 days
What would be the benefit of adding gentamicin to meningitis therapy?
Gentamicin increases bactericidal activity
What is the specific therapy for L. monocytogenes?
Ampicillin
Or
SMX/TMP or Meropenem as alternative
For 21 days or more
Why is rifampin used as prophylactic therapy? In what bug is it uses?
It is used in H. influenzae as a decolonizing tool
What are two main pathogens that are prophylaxed against?
H. influenzae
N. meningitis
What drug is used for prophylaxis against N. meningitis?
Rifampin x2 days
Cipro x 1 dose
IM Ceftriaxone x 1 dose
H. influenzae prophylaxis is not needed if patient has this…
Hib vaccine
