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Second Chance - Bacterial Meningitis
What lab values indicate meningitis? (MULTI)
Increased wbc count 1000+ (neutrophils/mono)
Increased protein
Decreased glucose
Increase glucose
Decrease wbc
Decreased protein
NB - 1 mo
S.pneumoniae, N.meningitidis, H.influenza, S.agalactiae
N.meningitidis, S.pneumoniae,
S.pneumoniae, N.meningitidis, gram neg enteric bacilli, Listeria
S.agalactiae, gram neg enteric bacilli, Listeria
1 month - 23 months
S.pneumoniae, N.meningitidis, H.influenza, S.agalactiae
N.meningitidis, S.pneumoniae,
S.pneumoniae, N.meningitidis, gram neg enteric bacilli, Listeria
S.agalactiae, gram neg enteric bacilli, Listeria
2-50 years
S.pneumoniae, N.meningitidis, H.influenza, S.agalactiae
N.meningitidis, S.pneumoniae,
S.pneumoniae, N.meningitidis, gram neg enteric bacilli, Listeria
S.agalactiae, gram neg enteric bacilli, Listeria
>50 years
S.pneumoniae, N.meningitidis, H.influenza, S.agalactiae
N.meningitidis, S.pneumoniae,
S.pneumoniae, N.meningitidis, gram neg enteric bacilli, Listeria
S.agalactiae, gram neg enteric bacilli, Listeria
NB - 1 mo
Vancomycin and cefotaxime or ceftriaxone
Vancomycin plus ampicillin plus cefotaxime or ceftriaxone
Vancomycin and cefotaxime or ceftriaxone
Ampicillin plus cefotaxime or ampicillin plus aminoglycoside
1 month- 23 months
Vancomycin and cefotaxime or ceftriaxone
Vancomycin plus ampicillin plus cefotaxime or ceftriaxone
Vancomycin and cefotaxime or ceftriaxone
Ampicillin plus cefotaxime or ampicillin plus aminoglycoside
2-50 years
Vancomycin and cefotaxime or ceftriaxone
Vancomycin plus ampicillin plus cefotaxime or ceftriaxone
Vancomycin and cefotaxime or ceftriaxone
Ampicillin plus cefotaxime or ampicillin plus aminoglycoside
>50 years
Vancomycin and cefotaxime or ceftriaxone
Vancomycin plus ampicillin plus cefotaxime or ceftriaxone
Vancomycin and cefotaxime or ceftriaxone
Ampicillin plus cefotaxime or ampicillin plus aminoglycoside
True/False: Dexamethasone 0.15mg/kg iv q6h x 2-4 days 10-20min before first abx should be given for meningitis
True
False
Once definitive, how long should antibiotics be continued?
IV antibiotics for 10-14 days
IV antibiotics for 5-7 days
IV antibiotics for 14-21 days
If Listeria was found, how long should treatment be for?
7 days
10 days
14 days
21 days
If nosocomial infection, what combination should be used?
Cefepime 2gm IV q8h + Vancomycin 15mg/kg IV q8-12h
Ceftriaxone 2gm IV q12h plus Vancomycin 15mg/kg IV q8-12h
Vancomycin + ampicillin
If patient allergic to beta-lactams, what can you use for meningitis?
Aztreonam (G-) + vancomycin
Cefepime 2gm IV q8h + Vancomycin 15mg/kg IV q8-12h
Vancomycin + ampicillin
If possible viral CNS infection, what is a possible empiric treatment?
Acyclovir 10mg/kg IV
Valacyclovir
Linezolid
Macrolides
What drug should not be used for CNS infections due to seizure risk?
Imipenam
Aztreonam
Meropenam
Levofloxacin
For nosocomial infection, if CSF cultures still (+) after 2 days of definitive tx, you can add: (MULTI)
Colistin
Preservative-free tobramycin
Sterilized tobramycin
Amikacin
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