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37 Cards in this Set

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  • Back
Acute, community acquired bacterial meningitis (18-50)
vanco 1g IV q12hr AND ceftriaxone 2g IV q12hr AND dexamethasone 10mg IV q6hr x 4days 15-20min before abx

(pneumococcal, meningococcal)
Acute, community acquired bacterial meningitis (>50)
amp 2g IV q4hr AND vanco 1g IV q12hr AND ceftriaxone 2g IV q12hr AND dexamethasone 10mg IV q6hr x 4days 15-20min before abx

(pneumococcal, listeria, GNB)
Acute, commnity acquired bacterial meningitis (pen/ceph allergy)
chloramphenicol 1g IV q6hr AND vancomycin +/- rifampin 300mg IV q12hr AND dexamethasone 10mg IV q6hr x 4days 15-20min before abx
TB meningitis (adults)
isoniazid 300mg QD (+pyridoxine 50mg QD) AND rifampin 600mg QD AND pyrazinamide 15-30mg/kg/d AND ethambutol 15-25mg/kg/day x 9-12 months

(may d/c pyr and etham after 2 months if susceptible)

dexa recommended especially w/ decreased level of consciousness
Brain abscess (predisposing condition unknown)
ceftriaxone 2g IV q12hr AND metronidazole 500mg IV q6hr
listeria monocytogenes
ampicillin AND gentamicin

Alt: bactrim
enterobacteriaceae (E.coli,etc)
haem influ
pseudomonas aeru
ceftazidime AND tobramycin
Prophylaxis considerations
meningococcal: rifampin 600mg q12hr x 2days

haem.influ: rifampin 600mg daily x 4days
Non-viral encephalitis (toxoplasmosis)
Pyrimethamine 100-200mg po once (loading dose), then 50-100mg PO qd + sulfadiazine 4-8 g PO qd OR clindamycin 900mg IV q6hr + folinic acid 10mg PO qd x minimum 6 weeks
Bacterial etiology of meningitis
1)strep. pneumo
The critical first step in acquisition of acute bacterial meningitis is?
nasopharyngeal colonization of the host
S/sx of meningitis
headache, nuchal rigidity, fever, stiffness of neck/back, brudzinski's sign, kernig's sign
What is brudzinski's sign?
neck sign: flexion of the neck by the examiner produces hip and knee flexion

leg sign: flexion of leg causes same flexion of contralateral leg then the reciprocal contralateral sign where leg extends spontaneously
What is kernig's sign?
examiner flexes hip 90 degrees to trunk and attempts to extend the knees causing "contracture" or extensor spasm at the knee 135 degrees (patient is unable to extend the leg at the knee due to hamstring stiffness)
Newborn-1 month empiric therapy
ampicillin AND ceftriaxone OR AG

(gram - enterics, group B strep, listeria)
1 month-4 years
ceftriaxone AND vanco

(haem influ, n. meni, s. pneumo)
5-29 years
ceftriaxone AND vanco

(n. meni, s. pneum, h. influ)
30-60 years
ceftriaxone AND vanco

(s.pneum, n.meni)
>60 years
ampicillin AND ceftriaxone OR AG AND vanco

(s.pneum, gram - enterics, listeria)
What distinguishes meningococcal meningitis from other bacterial causes?
Unique immune reaction: pt develops characteristic immunologic reaction of fever, arthritis, and pericarditis about 10-14 days after onset of dz and despite successful treatment.

no additional antibiotic therapy required, benefit from NSAIDs and supportive care
Primary clue that the underlying pathogen is n. meni?
presence of petchiae
a)Neurologic complications such as coma and seizure

s.pneumo or n.meni
a)s. pneumo
b)n. meni
pneumococcal vaccine
Prevnar approved for use in ages 2 months - 9 years
risk factors for listeria
neonates, immunocompromised, alcoholics, elderly
Incidence of listeria peaks when?
summer and early fall
Benefits of dexamethasone
lower incidence of neurologic sequalae
Diagnostic sign unique to tuberculosis meningitis?
paralysis of the VI cranial nerve, which initially is unilateral and then progresses to bilateral
Cryptococcus neoformans meningitis treatmnet
amphotericin B 0.5-1mg/kg/day AND flucytosine 100mg/kg/day
Side effects of flucytosine
bone marrow suppression and GI distress
AIDS-associated cryptococcal meningtitis treatment
Amphoterecin B w/wo flucytosine OR fluconazole alone

maintenance therapy w/ fluconazole or itraconazole for life of patient
Drug of choice for herpes simplex encephalitis
acyclovir 10mg/kg IV q8hr x 2-3wks
Alternative treatment for acyclovir-resistant herpes simplex virus
foscarnet 40mg/kg infused over 1 hr q8-12hr x 2-3wks
Major toxicity of foscarnet
renal impairment
Monitoring for foscarnet
seizures related to plasma electrolyte level alterations; imperitive to ensure adequate hydration
Duration of antibiotic treatment for meningitis
7-21 days depending on organism