Meningitis Flashcards
Which pathogen cause meningitis the most
- Strep pneumo
- N. meningitidis
- H. flu
- Listeria
Listeria is most likely to effect what groups
- Old
- Neonates
- Alcoholics
N. meningitidis is most common in what group
-College age teens
Clinical presentation
- Headache
- Fever
- Stiff neck
- Photophobia
Cerebrospinal Fluid changes in meningitis
- Increased WBC count
- Increased neutrophils
- Increased protein levels
- Decreased glucose levels
Diagnostics of Meningitis
CSF evaluation
-Gram stain and culture
Goals of Therapy
- Eradicate infection
- Decrease signs and symptoms of infection
- Prevent complications
Management of Meningitis
- Empiric abx
- Antiinflammatories
- Fluids
- Electrolytes
- Antipyretics
- Analgesics
Characteristics that improve abx penetration
- Low molecular weight
- Non ionized
- Low protein binding
- Lipophilic
Empiric therapy rules
- Initiate with in 30mins of presentation
- Continue for 48 to 72hrs or until diagnosis of meningitis can be ruled out
- Once pathogen is identified, narrow therapy
Empiric Meningitis Therapy
-Ceftriaxone
plus
-Vancomycin
Empiric Regimens in elderly, neonates, and alcoholics
- Have an increased risk of listeria
- Add ampicillin to the Vanco and Ceftriaxone
When to add Dexamethasone
Only for
- Strep pneumo
- H. flu
Treatment of N. meningitidis meningitis
- Ceftriaxone 2g IV q4-6h
- Drop Vanco, amp, dexamethasone
- Duration 7 days
When to do Prophylaxis for meningitis
- At least 4hrs of contact with infected
- Making out
- Resuscitation
N. meningitids prophylaxis
- Ceftriaxone 250mg IM X 1 dose
- alternative = Rifampin 600mg BID x 4 doses (2 days)
Treatment of S. pneumoniae meningitis
- Continue dexamethasone x 4 days
- Ceftriaxone
- Vancomycin (if MIC >1 add vanco)
- Duration 10-14 days
H. flu meningitis beta-lactamase negative
- Dexamethasone x 4 days
- Ampicillin
- Duration 7 Days
H. flu meningitis beta-lactamase positive
- Dexamethasone x 4 days
- Ceftriaxone/Cefotaxime
- Duration 7 Days
Prophylaxis for H. flu
-Rifampin 600mg qd x 4 days
Listeria monocytogenes treatment
-Ampicillin plus -Aminoglycoside x 10 days -Alternative is bactrim -Duration 21 days
