Mikesell Flashcards
where is the cerebrospinal fluid located
subarachnoid space
(where infection takes place)
compare the BBB and BCSF
BBB is 5000 bigger and harder to get into
characteristics that would help penetration
lipid soluble
unionized
free drug (non-protein bound)
low molecular weight
enhanced meninges inflammation
drugs able to get through without meninges inflammation
acyclovir
ganciclovir
TMP/SMX
fluconazole
voriconazole
linezolid
metronidazole
FQs
drugs able to get through with meninges inflammation
penicillins
3rd/4th gen cephalosporins (ceftriax and cefepime)
aztreonam
meropenem
vancomycin
drugs not able to get through the CSF
macrolides
aminoglycosides
beta lactamase inhibitors
1st/2nd gen cephalosporins
tetracyclines
clindamycin
echinocandins
ertapenem
types of acute bacterial meningits
hematogenous
direct inoculation
causative pathogens neonates <1 month
strep agalactiae
strep pneumo
neisseria
listeria
causative pathogens infants (1-23 months)
strep agalactiae
strep pneumo
neisseria
h. flu
causative pathogens children and adults <50
strep pneumo
neisseria
causative pathogens older adults >50
strep pneumo
neisseria
listeria
when do we start empiric antibiotics in acute bacterial meningitis?
after we get the lumbar puncture
CSF interpretation of acute bacterial
WBC high >1000-5000
>80% neutrophils
protein high
glucose low
positive gram stain
common pathogens in fungal meningitis
cryptococcus neoformans
cryptococcus gattii
soil fungus
CSF interpretation of fungal meningitis
WBC increased 10-500
>50% lymphocytes
protein high
glucose low
high opening pressure
common pathogens viral encephalitis
enteroviruses
arboviruses
CMV
VZV
HSV
presentation of viral encephalitis
extreme altered mental status
confusion, personality changes, memory impairment
CSF interpretation of viral encephalitis
WBC increased 5-300
50% lymphocytes
protein increased
glucose low
acute bacterial meningitis empiric treatment
neonates: ampicillin + gentamycin/ceftriax/cefe
infants: vancomycin + ceftriaxone
children/adults: vancomycin + ceftriaxone
older adults/immunocompomised : vancomycin + ceftriaxone + ampicillin
gram positive diplococci in pairs and chains
streptococci
streptococcus treatment
ampicillin or penicillin G
- ceftriaxone or vancomycin if resistant
x10-14 days
what should be adminstered before antibiotics
dexamethasone x 2-4 days
gram positive cocci in clusters
staph aureus
staph aureus treatment
MSSA: nafcillin
MRSA: vancomycin
x 14-21 days
gram positive rod, non spore forming
listeria
listeria treatment
ampicillin +/- gentamycin x 21 days
gram negative intra cellular diplococci
neisseria
neisseria treatment
penicillin G or ampicillin x 7 days
or ceftriaxone
gram negative coccobacillus
h. flu
h. flu treatment
beta lactamase neg: ampicillin
beta lactamase positive: ceftriaxone
x 7 days
other gram negative enterobacteriaceae treatment
ceftriaxone or cefepime
x 21 days
fungal meningitis induction treatment
amphotericin B + flucytosine (over 24h)
x 2 weeks
fungal meningitis consolidation treatent
fluconazole 400-800 mg PO or IV daily
fungal meningitis maintenance treatment
fluconazole 200 mg PO one daily
x 12 months
do we hold art in cryptococcus
until 5 weeks after initiating treatment for crytpcococcus especially in CSF<5
viral encephalitis treatmnt
supportive care
if VZV, HSV: acyclovir
if CMV: ganciclovir +/- foscarnet
