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25 Cards in this Set
- Front
- Back
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Symptoms of Meningitis
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fever
neck stiffness headache altered mental status focal neuro deficits |
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Physical exam findings for meningitis
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Brudzinski sign - hip/knee flexion with neck flexion
Kernig sign - when hip is flexed, you see hamstring contraction with knee extension purpura papilledema of eye bulging fontanelle |
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Meningitis Empiric therapy for neonate (< 1 mo)
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Amp + Gent
Amp + cefotaxime |
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Meningitis Empiric therapy for infant ( 1 - 23 mos)
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Vanc + cefotaxime/ceftriaxone
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Meningitis Empiric therapy for 2 - 50 yo
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Vanc + Cefotaxime/Ceftriaxone
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Meningitis Empiric therapy for > 50 yo
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Vanc + Amp + ceftriaxone/cefotaxime
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Organisms seen commonly in meningitis > 50 yo
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S Pneumonia
N meningitides H Influenzae |
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Organisms seen commonly in meningitis 2 - 50 yo
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S Pneumonia
N meningitides (H Influenzae, virus less common) |
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Organisms seen commonly in meningitis 2 mos to 2 years
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S Pneumonia
N meningitides H Influenzae Gr B Strep |
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Organisms seen commonly in meningitis < 2 mos
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Group B Strep
L. Monocytogenes S Pneumonia N meningitides |
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What organism in Children can dexamethsone be used
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H. INfluenzae
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What organism can dexamethasone be used for meningitis in adults
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S Pneumoniae
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When should dexamethasone administration be timed in meningitis
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10 - 20 min or at same time as ab's
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T/F dexamethasone administration may Decrease ab penetration in meningitis
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TRUE possible reduced penetration (Vac in animal models)
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What outcomes are improved by dexamethasone administration in adults and children in meningitis
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Adults - decr. mortality in s. pneumonia infection
CHildren - decr. hearing loss and neuro sequelae for H. Influenzae |
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WHo recieves chemo prophylaxis for N Meningitidis?
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Close contacts (household/day care) , exposure to oral secretions
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Drugs used for prophylaxis of N Meningitidis
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Rifampin x 4 doses (600mg bid adult, 10mg/kg bid kids)
cipro 500mg x 1 - adults only ceftriaxone 250mg IM x 1 |
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WHo recieves chemo prophylaxis for H Influenzae?
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Close contacts (household/day care) , exposure to oral secretions
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Drugs used for prophylaxis of H Influenzae
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Rifampin x 4 doses
600mg daily adult 20mg/kg/d children 10mg/kg/d infant (< 1) |
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Specific therapy for common CNS pathogen.
S Pneumonia |
MIC < 0.1
Pen G 4 mill. u q 4 hrs Amp 2 g IV q 4 hrs MIC 0.1 - 1 3 rd gen ceph. OR cefepime / meropenem MIC > 2 Vanc + 3rd Gen Ceph Moxiflox |
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Specific therapy for common CNS pathogen.
N. Meningitides |
An MIC less than 0.1 mcg/mL
Penicillin G 4 million units intravenously every 4 hours Ampicillin 2 g intravenously every 4 hours Alternative: Third-generation cephalosporin or chloramphenicol An MIC 0.1–1.0 mcg/mL i. Third-generation cephalosporin ii. Alternative: Chloramphenicol, fluoroquinolone, or meropenem |
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Specific therapy for common CNS pathogen.
H. Influenzae |
β-Lactamase negative
i. Ampicillin 2 g intravenously every 4 hours ii. Alternative: Third-generation cephalosporin, cefepime, chloramphenicol, or fluoroquinolone b. β-Lactamase positive i. Third-generation cephalosporin ii. Alternative: Cefepime, chloramphenicol, or fluoroquinolone |
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Specific therapy for common CNS pathogen.
S. agalactiae |
A. Penicillin G 4 million units intravenously every 4 hours
b. Ampicillin 2 g intravenously every 4 hours c. Alternative: Third-generation cephalosporin |
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Specific therapy for common CNS pathogen.
L. Monocytogenes |
a. Penicillin G 4 million units intravenously every 4 hours
b. Ampicillin 2 g intravenously every 4 hours c. Alternative: TMZ/SMZ or meropenem |
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What is therapy length for meningitis ( Based on Clinical Experience, Not on Clinical Data)
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1. N. meningitidis: 7 days
2. H. influenzae: 7 days 3. S. pneumoniae: 10–14 days |
