Treatment of meningitis Flashcards
بسم الله الرحمن الرحيم
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the cranial nerve affected in bacterial meningitis is ?
CN 8 vestibulochoclear
بسم الله الرحمن الرحيم
___________________
the cranial nerve affected in bacterial meningitis is ?
CN 8 vestibulochoclear hearing loss
Durg induced meingitis
by ?
NTI
-NSAIDS
-Trimethoprims / Sulfamethaxazole
-IV immungoglobulin G
_______________________-
As hypersnensitvity in SLE and RA
SO cessation !
Triad of baterical meningits ?
1-High Fever!
2-Headache Or altered Conscousness
3-Neck rigidity or stifness
How to mangae bacterial meningiits
acmd 1-Antibiotic for bcateria
2-Corticosteroids for inflammation
3-Mannito decrearsing ICP
-Diazpam for seizures
Increased ICP in bacterial menignitsi is due to ?
CIV 1-Vasgoenic edema increased peramibility Of BBB due to endothelis damage
2-Interstitial edema due to Obstruction of CSF Flow due to neutrophils in subarachanoid space producing inflammatory excudate obstruvting the CSF!
3-Cytotoxic edema in brain tissue
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Vascultitis = ischemia due to cytokines INTERPETING BLOOD FLOW increasing ICP
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Neuronal damage and CN8 seizures
Intersitial edema in bacterial menigitis is due to ?
Interstitial edema due to Obstruction of CSF Flow due to neutrophils in subarachanoid space producing inflammatory excudate obstruvting the CSF!
Managemetn of Bacteial meningiits?
Initial Dexa + empriric antibiotic
Pathogen specific antibiotic
Shemopropylaxix to contacts
Managemetn of Bacteial meningiits?
Initial Dexa + empriric antibiotic
Pathogen specific antibiotic
Shemopropylaxix to contacts
INtital magmetn of bacterial menigits
Dexa 10/20 minuts before the empric antibiotic ! or concomitanntly
for 2-4 days
Dexa dose in bacterial menigits
0,15mg/kg/6hours IV!
Dexa imp in bacterial meigits
Decreasing Inflammaroty cells and cytokines and the inflmmatory reacgtion and vascultits
decresaing brain edema and neurotoxicity
Empric antibiotic is ABCDEF
Antibiotic Broad Parentral Cidal Combination 2-4days Epmprical Full dose
intavenous
When intrathecal injection of Emprici antibiotic
Nosocomial menigits
Non responsing IV ANTIBIOIT
Hydrophilic = gentamycin - vancomycin
Never pecellin and cephalosprins intrathecally = neruotoxic and seizure
Population below 1 month tha pathogen is ,,,,,,,,,, &,,,,,,,&,,,,,,,,&othe gram - bacilli
Emprical is ……….+………
or …….+………
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1-23 months
2-50 years the pathogen …………..&,,,,,,,,,,,&,,,,,,,,,,,,,,,&,,,,,,,,,,,,,,
empric is ……..+……
or…..+……..
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>50years or imuuno comprismed or alcholo
………………&,,,,,,,,&,,,,,,,,,,
AND aeerobic geam-bacilli
Empric is ?
,,,,,,,AND,,,,,,AND,,,,,,,,,,,
OR
,,,,,,,,,AND ,,,,,,,,,
=Streoptcoccus aglactiae - Listera -E COLI SLE
Ampicclin + cefotaxime
Ampicllim+ gentamycin
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=S,peunonaie , N.meingiitds , S,agalcite , H,inglezuae
Vanocmycin +ceftriaxone
Vancomycin + meropenem….
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=S.pnemuona + listera + N,meidigits
Vancomycin + Ceftirzxone + Ampicllin
Vanocmycin + meropenem
Penterating trauma
Neurosurgery
CSF shunt
Bactrial meinigits pathogen is ?
emprical antibiotics is ?
Coagulae - staphs MRSA
Aerobic gram - bacilli pseudomonas
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Vancomycin + cefepime
Vancomycin + meropenem
To increase it csf permeability Ceftriaxone is given with ?
Rifampin
Sterptococcus pnemnoia duration of treatment +
recommednded and alternative antibiotics
10-14 days
Penicllin MIC < 0.1
penecillin G or Ampicllin
Penecillin MIC 0.1-1
Ceftriaxone
Ceftriaxone mic >2
Ceftiraxone + vanomycin
Cef + Rifampin
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alterntaic CMM
Meropenem
Moxifloxcain
Cholramhpenicol
N,meingitids duration of treatment +
recommednded and alternative antibiotics
7 days
Penecillin mic <0.1
penicclin G or ampicllin
Pencelin mic > 0.1
ceftiaxone
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Alternative
Meropemen
Moxifloxacin
Choramhenicol
H.infleuze duration of treatment +
recommednded and alternative antibiotics
7-10D
B lactamase + = ampicllin
B lactamase - = Ceftrizxone
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Alternative
Meropenem
Moxifloxacin
Cholramphenicol
Streptococus aglactiae duration of treatment +
recommednded and alternative antibiotics
21 days
Penicillin G ampicllin
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Vanocmycin + cefotaxime
Listera duration of treatment +
recommednded and alternative antibiotics
21 days
Ampicclin + gentamycin for synergism
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Trimethoprim / sulfmethaxazole
Enterobacteria :duration of treatment +
recommednded and alternative antibiotics
21 days
Ceftriaxone
Gentamycin
_________
meropenem
Moxifloxacin
[pSUDOMONAS S duration of treatment +
recommednded and alternative antibiotics
21 D
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Cefepim
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Meropenem
Ciprofloxacin
Stap aerues duration of treatment +
recommednded and alternative antibiotics
14 days
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Methecillin sensitive = Naficllin
Resistant = Vancomycin
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alternativesss:-
Daptomycin
Liezolid
شفا الله كل مريض يتجرع نغب الآلام أنفاسا كأسا تلو كأس نفس تلو نفس !
In adult
Ampicllin 2g q4h
ceftriaxone 2g q12h
Vanocmycin 15mg/kg q8h
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In childrem
ampicllin
50-100mg/kg q6h
ceftrizaxone 12 -24
cefotaxime 6-8 h
(75-100 mg /kg)
Aminoglycoside :- Gentamycin or tobramycin 2.5 mg/kg q8h
Vancomycin :- 15 mg /kg q6h
Cholreamphenicol : 25 mg/kg orally or intravenous q 12h
Chloramphenicol is last choice why?
Fatal aplastic amemia
Grey baby sndomre in neonate
Chemoprphylaxis :-
H.Influenza : indications 1-2
antibiotis is ……… for……. dose………..up to,…….
=N,mengitidis :1-2-
no need contact >14 days
antiviotic ?,m,,,,,,,,,, for……
alternatices ………. IMand……… only adult
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S.aglacitae
1-
2-
3-
antivioticm,,,,,,,,,,,,,,,,,IV
allergy ?,,,,,,,,or,,,,,,,,,,,,,,,,,,,,,,,,,
Household contacts
Unvcaiinate or incompletely vaccinate children
Rifampin for 4 days
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1-close contact for 8 hours
2-Contact with oral secretions
Rifampin for 2 days
Ceftriaxone
Cefofloxacin
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Prevous birh with infected child
Colonization
Baturia during pregnancy
Fever + amionitc fluid rubture
labor < 37 weeks
=Pencillin G or
Cefazolin and CLINDAMYCIN
vIRAL menigits by herpes simplex giving ?
Acyclovir
candidal menigits ?
Aspergillius menigitis?
candia = liposomal ampotrecin B
lESS NEPHROTOXIC + Higher CNS CONC + 5 fluocytosine
Aspergillus = Voriconazole
TB meingitis
Combination of first line anti tb drugs
for 9 -12 months
Isoniazid -pyraziamide - fifamon -ethabutlo -streptomycin
الحمدلله رب العالمين
