Meningitis

Question 1

What are the most common pathogens in infants 1 to 23 months?

Answer 1

Strep. agalactiae
E. coli 
Haemophilus influenzae
Strep. pneumoniae
Neisseria meningitidis

Question 2

What are the most common pathogens in those 2 to 50 years old?

Answer 2

Strep. pneumoniae

Neisseria meningitidis

Question 3

What are the most common pathogens in those over 50 years old?

Answer 3

Strep. pneumoniae
Neisseria meningitidis
Listeria monocytogenes
Aerobic gram (-) bacilli

Question 4

What are the most common pathogens in infants less than 1 month?

Answer 4

Strep. agalactiae
E. coli
Listeria monocytogenes
Klebsiella pneumoniae

Question 5

What drugs are effected MAXIMALLY and MINIMALLY by steroids

Answer 5

Maximal Effect: vancomycin and beta-lactams

Minimal effect: rifampin and fluoroquinolones

Question 6

What is meningitis?

Answer 6

Inflammation of the MEMBRANE of the brain, spinal cord, and cerebral spinal fluid

NOT inflammation of the brain itself

Question 7

What are risk factors for meningitis?

Answer 7

Extreme ages (very young and very old)
Immune defects
Close living conditions
Cig smoke exposure
Respiratory infection

Question 8

What are the differences in WBC levels?

Answer 8

Normal: 5
Bacterial: 1000-5000
Viral: 100-1000

Question 9

What are the differences in WBC differentials?

Answer 9

Normal: >/= 85% monocytes
Bacterial: >/= 80% PMNs
Viral: 50% lymphocytes

Question 10

What are the differences in CSF:serum glucose ratios?

Answer 10

Normal: >/= 0.6
Bacterial: = 0.4
Viral: >/= 0.6

Question 11

What is the empiric treatment for those under 1 month?

Answer 11

Amp + cefotaxime
or
Amp + AG

Question 12

What is the empiric treatment for those 1 to 23 months?

Answer 12

Vancomycin + cefotaxime/ceftriaxone

Question 13

What is the empiric treatment for those 2 to 50 years old?

Answer 13

Vancomycin + cefotaxime/ceftriaxone

Question 14

What is the empiric treatment for those over 50 years?

Answer 14

Vancomycin + Amp + Cefotaxime/Ceftriaxone

Question 15

Drug of choice for S. pneumoniae with a PCN MIC

Answer 15

Ampicillin

10-14 days

Question 16

Drug of choice for S. pneumoniae with a PCN MIC 0.1 to 1.0

Answer 16

Ceftriaxone or Cefotaxime

10-14 days

Question 17

Drug of choice for S. pneumoniae with a PCN MIC >/= 2.0

Answer 17

Vancomycin + Ceftriaxone/cefotaxime

10-14 days

Question 18

Drug of choice for S. pneumoniae with a Cephamycin MIC >/= 1.0

Answer 18

Vancomycin + Ceftriaxone/cefotaxime

10-14 days

Question 19

What would be the benefit of adding gentamicin to meningitis therapy?

Answer 19

Gentamicin increases bactericidal activity

Question 20

What is the specific therapy for L. monocytogenes?

Answer 20

Ampicillin

Or

SMX/TMP or Meropenem as alternative

For 21 days or more

Question 21

Why is rifampin used as prophylactic therapy? In what bug is it uses?

Answer 21

It is used in H. influenzae as a decolonizing tool

Question 22

What are two main pathogens that are prophylaxed against?

Answer 22

H. influenzae

N. meningitis

Question 23

What drug is used for prophylaxis against N. meningitis?

Answer 23

Rifampin x2 days

Cipro x 1 dose

IM Ceftriaxone x 1 dose

Question 24

H. influenzae prophylaxis is not needed if patient has this…

Answer 24

Hib vaccine

Question 25

In what bugs do we normally use steroids, what populations?

Answer 25

H. influenzae in infants

S. pneumoniae in adults