Treatment of CNS and Respiratory Infections Flashcards
What antibiotics typically don’t reach sufficient levels in the CSF?
the 30S inhibitors -> tetracyclines / aminoglycosides, + polymyxins
What is the empiric coverage we use for meningitis in patients <1 month?
Ampicillin + gentamicin or cefotaxime (3rd generation not ceftriaxone)
Gentamicin is okay because patient has no BBB
What is the empiric coverage for meningitis in patients 1-23 months of age and why?
Vancomycin + 3rd generation cephalosporin
Use vancomycin for possibility of mildly elevated MICs of Streptococcus pneumoniae which would not allow killing by cephalosporin in CSF
What is the only difference between treating adults under 50 and children for CNS infection?
Adults get Dexamethasone prior to first antibiotic dose
What is the purpose of giving dexamethasone?
It is a steroid to decrease inflammation in subarachnoid space and thus decrease neurological sequelae
What must be added onto the antibiotic regimen for adults >50 and why?
ampicillin, for listeria coverage
So regimen is:
ampicillin + vancomycin + ceftriaxone
What can be used against Listeria if patient is allergic to ampicillin?
TMP/SMX
Who gets prophylaxis for meningitis caused by N. meningitis and H. influenzae and what is it?
N. meningitis - anyone exposed to oral secretions and household contacts - Ciprofloxacin 500 mg or rifampin
H. influenzae - everyone in a household with unvaccinated children (might spread to them) - Rifampin
What is the most common causative pathogen in CSF shunt infections, and what is the recommended empiric treatment?
Usually coag-negative staph (from skin)
Recommended broad therapy: Vancomycin + cefepime or ceftazidime
What is the basic treatment for all fungal CNS infections minus Coccidio?
Lipid Amphotericin B + flucytosine for all
Blasto and Histo longer therapy, and longer oral therapy
Recommend switching to oral azole therapy after a few weeks
What is the recommended therapy for only Coccidio CNS infection?
High dose fluconazole
Typically acute bronchitis is not treated. What are the exceptions? What is used to treat?
Mycoplasmal, chlamydial, or B. pertussis
All use Macrolides with second line doxycycline
During a COPD exacerbation, who gets antibiotics?
Only those with increased sputum purulence
What are the most common bugs for COPD exacerbation?
S. pneumoniae, H. influenzae, M. catarrhalis (typical pathogens)
With some Chlamydia or mycoplasma
What is the first-line treatment for COPD exacerbation?
Doxycycline, with second-line amoxicillin/clavulanic acid