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Clinical Pharmacology > Meningitis > Flashcards

Meningitis Flashcards

1
Q

Which drugs to use if the gram-stained smear of CSF indicates pneumococcal or meningococcal disease?

A

Penicillin G or Cefotaxime/Ceftriaxone.
Pneumococcal: 2 weeks
Meningococcal: 1 week

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2
Q

Penicillin G - Dose and route

A

3g x 4 IV for 21 d

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3
Q

Ceftriaxone - Dose and route

A

4g x 1 IV
Meningococcal - 7 d
Pneumococcal - 10-14 days
Gram (-) - 14-21 d

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4
Q

Ceftriaxone - MoA

A

3rd generation cephalosporin. Inhibits bacterial cell wall synthesis

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5
Q

Ceftriaxone - Adverse effects

A

Hypersensitivity (rare, cross-sensitivity to penicillins):
Anaphylaxis, fever, skin rashes, nephritis, granulocytopenia, hemolytic anemia

Local irritation: pain after IM injection, thrombophlebitis after IV

Renal toxicity (intersitial nephritis, tubular necrosis)

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6
Q

Ceftriaxone - Contraindications

A

Allergy to cephalosporins and penicillin
Newborns with jaundice
Hypoalbuminemia

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7
Q

Alternative drugs for patients with penicillin allergy

A

Meropenem and vancomycin/chloramphenicol

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8
Q

Meropenem - Dose and route

A

2g x 3 for 10-14 days

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9
Q

Meropenem - MoA

A

Carbapenem. Inhibits bacterial cell wall synthesis

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10
Q

Meropenem - Adverse effects

A 
Cross-sensitivity with penicillin allergy
Seizures in patients with epilepsy 
Diarrhea
Vomiting
Anemia
Leukopenia
Thrombocytopenia
Altered bleeding time
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11
Q

Meropenem - Contraindications

A

Allergy to penicillins and cephalosporins

Caution in patients with brain damage and decreased kidney function

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12
Q

Vancomycin/Chloramphenicol - Dose and route

A

Vancomycin: 30-60 mg/kg/day
Chloramphenicol: 1g x 4 IV for 10-14 days

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13
Q

Vancomycin - MoA

A

Inhibit bacterial cell wall synthesis

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14
Q

Vancomycin - Adverse effects

A

Reduced nephro- & ototoxicity now compared to before
Hypotension and erythematous rash with to quick infusion (called red man syndrome)

Vestibular dysfunction (ataxia, vertigo, nystagmus, nausea)

Cochlear dysfunction (tinnitus, hearing loss)

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15
Q

Vancomycin - Contraindications

A

Patients with reduced hearing

Caution in patients with decreased renal function

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16
Q

Vancomycin - Interactions

A

Increased nephro- and ototoxicity with aminoglycosides, amphotericin B

17
Q

Chloramphenicol - MoA

A

Protein synthesis inhibitor.

18
Q

Chloramphenicol - Adverse effects

A

Gray baby syndrome characterized by cyanosis, weakness, respiratory depression, and shock

Reversible, dose-dependent anemia caused by blockade of iron incorporation into heme

Nausea, vomiting, diarrhea,
Oral/vaginal candidiasis

19
Q

Chloramphenicol - Contraindications

A

Pregnancy
Caution in kidney and liver dysfunction, premature, newborns
Prophyria

20
Q

Bacterial Meningitis- Diagnosis

A

Clinical presentation:

  • Triad: fever, headache, nuchal rigidity (Kernig & Brudzinski’s sign)
  • Decreased level of consciousness and raised ICP (Cushing reflex; bradycardia, HTN, irregular resp)
  • Rash of meningococcemia; Tumbler test

Tests:

  • Blood culture
  • CBC (Leukocytes!), ESR, CRP, Electrolytes, Glucose, INR, APTT, Renal and liver function tests
  • Urine pneumococcal antigen test
  • LP: CSF analysis; CSF culture, CSF Gram’s stain, CSF bacterial PCR. CSF glucose is low (glucose<2,2 mmol/L, <40 mg/dL), neutrophils predominate, proteins>0,45g/L)
  • Latex agglutination test
  • Limunus lysate: Gram (-) meningitis

Imaging:
MRI
CT

Biopsy: petechial skin lesions –> Gram’s stain
Culture of throat swab: meningococcal disease

21
Q

Bacterial meningitis- Differential diagnosis

A
  • HSV encephalitis
  • Ehlirchioses
  • Rickettsial disease
  • Brain abscess
  • Subarachnoid hemorrhage
  • Tumor
  • Meninigtis related to inflammatory disorders – SLE or Behet
  • Pituitary apoplexy
  • Subacute meningitis – M. tuberculosis & C. neoformans
22
Q

Meningitis - Empirical antibiotic therapy + Doses

A

Infants: Ampicillin+ Ceftriaxone
Immunocompotent children > 3 months, Adults <55 y: Ceftriaxone + Vancomycin
Adults> 55, alcoholism etc: Ceftriaxone + Ampicillin + Vancomycin
Hospital acquired, post-trauma, post-surgery: Ampicillin + Meropenem + Vancomycin

Ampicillin- 3gX4 IV
Ceftriaxone - 4g X 1 IV
Vancomycin - 60 mg/kg x1 IV
Meropenem - 2g X 3IV

23
Q

Acyclovir - MoA

A

Nucleoside analogue

24
Q

Acyclovir - Adverse effects

A

Headache, GI disturbances, rash

25
Q

Acyclovir - Interactions

A

Increases concentration of lithium and cyclosporin

26
Q

Acyclovir - Contraindication

A

Hypersensitivity to valacyclovir and acyclovir

27
Q

Acyclovir - Dose

A

10 mg/kg every 8 h IV followed by 800 mg X 5 daily PO for 10-14 days.

28
Q

Vancomycin - Dose

A

30-60 mg/kg divided into 2-3 doses

29
Q

Viral meningitis - Diagnose

A

CBC (Leukocytes!), CRP, ESR, Electrolytes, Glucose, Renal and liver function tests, Creatinine, glucose, amylase, lipase
CSF analysis: Pleocytosis (Lymphocutes predominate), Normal or slightly elevated protein concentration 20-80 mg/dL, Normal glucose concentration, Normal or mild elevated opening pressure 100-350 mmH20, Organism NOT seen on Gram stain of CSF, ) Total CSF cell count in viral meningitis is 25-500/uL
PCR of viral-specific DNA or RNA from CSF
PCR of throat washings or stool
Culture: CSF, throat swab, stool blood, urine
MRI: altered consciousness, seizures, neurologic signs

30
Q

Viral meningitis- Differential Diagnosis

A

Untreated or partially treated bacterial meningitis
Bacteria, fungal, tuberculous, spirochetal or other infectious causes of meningitis
Neoplastic meningitis

31
Q

Viral Meningitis - Treatment

A

Symptomatic; Analgesics, antipyretics, antiemetic. Monitor fluid and electrolyte status
Immunocompromised, neurologic alterations, elderly, seriously ill pts:
Acyclovir

32
Q

Meningitis - Vaccines

A

Meningococcal B
Pneumococcal conjugate vaccine (PCV)
Pneumococcal polysaccharide vaccine (PPV)
BCG

33
Q

Listeria Meningitis - Treatment

A

Ampicillin 3 g X 4 IV + Gentamycin - 2mg/kg IV loading dose then 7,5 mg/kg per day given every 8 h
Duration: 21 days

34
Q

Viral meningitis- Most common pathogens

A

Enteroviruses!

VZV, HSV (type 2) HIV, Arbo

Clinical Pharmacology (14 decks)

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