neuro antibiotics

Question 1

acute pyogenic meningitis

Answer 1

3rd gen cephalosporin (cefotaxime, ceftriaxone)
Vancomycin (glycopeptide)
if >50 add ampicillin (aminopenicillin)

Question 2

acute pyogenic meningitis in immunocompromised

Answer 2

Vancomycin + ampicillin + cefepime (4th gen cephalosporin) or meropenem (carbapenem)

Question 3

acute pyogenic meningitis in beta-lactam alergy

Answer 3

vancomycin +moxifloxacin (fluoroquinolone)

if >50 = vancomycin + moxifloxacin + trimethoprim-sulfamethoxazole

Question 4

beta lactam allergy

Answer 4

aminopenicillin and cephalosporins

Question 5

vancomycin side effects

Answer 5

red man syndrome

administer with antihistamine

Question 6

Trimethoprim + sulfamethoxazole side effects

Answer 6

increases warfarin levels

patients with AIDS

Question 7

brai abscess tx

Answer 7

penicillin G
Metronidazole 
ceftriaxone
ceftazidime, cefepime, or meropenem
vancomycin

Question 8

metronidazole

Answer 8

tx for brain abscess
affective against G- 
disrupts DNA synthesis 
antiprotazoal drug as well 
avoid alcohol 
metallic taste

Question 9

cetriaxone

Answer 9

covers aerobic and microaerophilic strep and enterobacteriaceae
cefotaxime has similar coverage

Question 10

ceftazidime, cefepime, meropenem

Answer 10

used when abscess complicates neurosurgical procedure

covers Pseudo Aeruginosa

Question 11

vancomycin

Answer 11

Brain abscess tx following trauma 
Staph aureus 
hospital acquired infections
where community MRSA is common 
- no MRSA = no vancomycin

Question 12

subdural empyema tx

Answer 12

surgery 
Cefotaxime or ceftriaxone 
vancomycin 
metronidazole 
Pseudo or MRSA = meropenem and vancomycin

Question 13

cryptococcal meningoencephalitis tx

Answer 13

amphotericin B (membrane dysfunction)
flucytosine (5-fluorouracil)
fluconazole (consolidation phase of therapy, ergosterol synthesis interuption)

Question 14

amphotericin B

Answer 14

complexes with ergosterol and disrupt fungal membrane 
given IV, not orally
renal toxicity 
acute febrile action 
anemia 
phlebitis

Question 15

flucytosine

Answer 15

inhibits fungal DNA synthesis
bone marrow depression
nausea, diarrhea

Question 16

fluconazole

Answer 16

inhibits ergosterol synthesis by inhibiting fungal P450 enzymes 
good CSF penetration 
drug interactions with P450 enzymes 
GI symptoms
widest therapeutic index of all azoles

Question 17

do not use to treat CNS infections

Answer 17

Aminoglycosides (streptomycin, gentamicin)
erythromycin
tetracyclines
clindamycin
1st gen cephalosporins (cefazolin)