Meningitis important stuff Flashcards
Classic signs and symptoms of acute bacterial meningitis include what? (classic triad)
1) Fever
2) Nuchal rigidity
3) Altered mental status OR headache
True or false: The first dose of antibiotics should not be withheld, even when lumbar puncture is delayed or neuroimaging is being performed.
“will be on exam”
True
1) What happens if you give abx before you get samples?
2) Should you still give abx if unable to get samples within an hour?
1) Sensitivity and specificity decrease
2) Yes
It is strongly recommended that the time from suspected diagnosis to initiation of antibiotic treatment should not exceed how long?
1 hour
“will be on exam”
Antibiotics having _____ molecular weights are passed more easily through biologic barriers, as do more __________ soluble abx and those that are unbound
low; lipid
What are the 3 most likely organisms if a meningitis pts is <1mo old?
“important”
1) S. agalactiae
2) Gram negative enterics
3) L. monocytogenes
[tx w. ampicillin + cefotaxime + aminoglycoside]
What 4 bacteria should you suspect in a meningitis pt between 1 and 23 months old?
“important”
1) S. pneumoniae
2) N. meningitidis
3) H. influenzae
4) S. agalactiae
[tx w. Vanc. + cefotaxime or ceftriaxone (3rd gen ceph.)]
What 2 bacteria should you suspect in a meningitis pt between 2 and 50 years old?
“important”
1) N. meningitidis
2) S. pneumoniae
[tx w. Vanc. + cefotaxime or ceftriaxone (3rd gen ceph.)]
What are the 4 most likely organisms if a meningitis pt is >50yrs old?
“important”
1) S. pneumoniae
2) N. meningitidis
3) Gram-negative enterics
4) L. monocytogenes
[tx w. Vanc. + ampicillin + cefotaxime or ceftriaxone (3rd gen ceph.)]
What are the empiric therapies for the following age groups for meningitis?:
1) <1mo
2) 1-23 months
3) 2-50 years
4) >50 years
“important”
1) Ampicillin + cefotaxime + aminoglycoside
2) Vanc. + cefotaxime or ceftriaxone (3rd gen ceph.)
3) Vanc. + cefotaxime or ceftriaxone (3rd gen ceph.)
4) Vanc. + ampicillin + cefotaxime or ceftriaxone (3rd gen ceph.)
What should you NOT use to Tx neonates? Why?
Ceftriaxone; can cause Kernicterus
1) If a pt has a penicillin-susceptible G+ form, what should you give?
2) What abt if G+ and ceftriaxone resistant?
starred slide
1) Penicillin G or ampicillin
2) Moxifloxacin
1) What do you give if a pt has a methicillin-susceptible G+ strain?
2) What abt is the alt. abx if G+ and methicillin resistant?
starred slide
1) Naficillin or oxacillin
2) TMP-SMX or Linezolid (B-III)
1) What should you give a pt with group B strep meningitis?
2) What if S. epidermidis?
starred slide
1) Penicillin G or ampicillin +/- gentamicin
2) Vancomycin
1) What is the drug of choice for L. monocytogenes meningitis?
2) What are other options?
3) How long should Tx be?
starred slide
1) Ampicillin
2) Gentamicin or penicillin
3) 21 days
Generally meningitis should be treated for about 2-3 weeks, but what are the exceptions?
starred slide
If G negative or Listeria (listeria like 21+ days; G- can be 7-10 days)
1) How long should you Tx N. meningiditis or H. influenzae meningitis?
2) How should you Tx G negative penicillin resistant organisms?
starred slide
1) 7-10 days
2) Meropenem or moxifloxican
How do you Tx a pt with P. aeruginosa meningitis?
starred slide
Cefepime or Ceftazidime and/or Tobramycin
What can you NOT give pregnant pts?
Rifampin or fluroquinolones
Haemophilus influenzae type b meningitis:
1) What is beneficial for treatment of infants and children with Hib meningitis to diminish the risk of hearing loss, if given before or concurrently with the first dose of antimicrobial agent(s)?
3) For prophylaxis, ______________ should be administered orally, once a day for ___ days (20 mg/kg/dose; maximum, 600 mg).
(not bolded just seems odd/ important)
1) Dexamethasone
2) rifampin; 4
When you hear strep B, you should be thinking of what?
Babies
“Transmission usually involves *colonization of the patient’s GI tract** with the organism, which then penetrate the gut lumen.”
This describes what bacterial form pf meningitis?
Listeria monocytogenes
Listeria monocytogenes: What is a good empiric therapy to opt for?
Ampicillin monotherapy
Listeria monocytogenes:
1) High failure rates with ____________.
2) What lack in vitro activity against L. monocytogenes?
(highlighted in different color)
1) vancomycin
2) Third-generation cephalosporins
Recommendations by the IDSA call for the use of adjunctive dexamethasone in infants and children, and you may see recommendations as early as 2 months old+ with ____________ meningitis
H. influenzae
Out of all abx, which has the worst increased risk of oral contraceptive failure via CYP450 enzyme induction?
Rifampin
When to give dexamethosone:
1) H. influenzae meningitis: recommendations by the IDSA call for the use of adjunctive dexamethasone in infants and children (6 weeks old+)
-0.15 mg/kg every 6 hours for 2 to 4 days, initiated 10 to 20 minutes prior to or concomitant with the first dose of antibiotics
2) Pneumococcal meningitis
-Pediatrics: consider risk vs. benefit
-Adults (suspected or proven): 0.15 mg/kg (up to 10 mg) every 6 hours for 2 to 4 days with the first dose administered 10 to 20 minutes prior to first dose of antibiotics
3) Pros/ Cons:
-Associated with lower rates of hearing loss and short-term neurological sequelae in adults and children
-Potential concern is that adj. therapy may reduce the penetration of antibiotics
What age group would you expect to see H. influenzae meningitis in?
1-23 months
H. influenzae:
1) Prevention?
2) Prophylaxis?
1) Vaccines
2) Rifampin PO QDay for 4 days (20 mg/kg/dose; maximum, 600 mg).
N. meningitidis
1) Prevention?
2) Prophylaxis?
1) Vaccines
2) Antimicrobial chemoprophylaxis of close contacts should be started as soon as possible (ideally <24 hours after identification of the index patient). In general, rifampin, ceftriaxone, and ciprofloxacin are recommended for prophylaxis, however
Streptococcus agalactiae (Streptococcus Group B)
1) Prevention?
2) Prophylaxis?
1) None
2) Intrapartum options are: penicillin, ampicillin, cefazolin (if penicillin allergy and not at high risk for anaphylaxis), or vancomycin (if penicillin allergy and at high risk for anaphylaxis)
-Penicillin G: 5 million units IV initially (started at time of labor or rupture of membranes), then 3 million units IV every 4 hours until delivery (guideline dosage)
What are the 2 reasons you’d opt for dexamethasone?
1) Empiric therapy
2) If you know pt has H. influenzae or pneumococcal meningitis
