CNS Infections

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What are the most likely pathogens for meningitis in newborns?
- E. coli
- Klebsiella spp
- S. agalactiae
- Enterobacter spp
What are the most likely pathogens for meningitis in 1mo - 29yo?
- N. meningitidis
- S. pneumoniae
- H. influenzae
What are the most likely pathogens for meningitis in 30-72yo?
- S. pneumoniae
- N. mengitidis
What causes problems with drug concentrations in the CSF?
- age dependent volume
- constantly produced
- constant flow
What considerations should be applied to selection of antibiotic therapy for meningitis?
- Low protein binding
- lipid soluble
- small molecular weight
- unionized at physiologic pH
- Absence or presence of meningeal inflammation
Which antibiotics do not rely on inflammation of the meninges to treat meningitis?
- Bactrim
- Chloramphenicol
- Isoniazid
- Rifampin
- Linezolid
Which antibiotics rely on inflammation of the meninges to treat meningitis?
- Ampicillin
- Aztreonam
- Cefotaxime
- Ceftazidime
- Cedftriaxone
- Cefuroxime
- Ciprofloxacin
- Levofloxacin
- Imipenem/Meropenem
- Pen G
- Piperacillin
- Ticarcillin
- Doxycycline
- Vancomycin (and still not very good penetration)
- TCNs
- Tigecycline
What is the empiric therapy for meningitis in neonates?

Ampicillin + 3rd gen ceph + Vancomycin
What is the empiric therapy for meningitis in 3mo - 50yo?

3rd gen ceph +/- Vancomycin
What is the empiric therapy for meningitis in >50yo?

Ampicillin + 3rd gen ceph +/- Vancomycin
What is the treatment for meningitis caused by S. pneumoniae?
- Pen G (DOC)
- Ceftriaxone (used more often than Pen G d/t convenience)
- Cefuroxime
- Chloramphenicol (almost never used)
- Vancomycin
What is the treatment for meningitis caused by Pen-resistant S. pneumoniae (PRSP)?

Vancomycin + Rifampin, FQ, or Linezolid
What is the treatment for meningitis caused by H. influenzae?
- Ampicillin (DOC if B-Lactamase neg.)
- Ceftriaxone (DOC if B-lactamase pos.)
- Chloramphenicol
- FQ
- Bactrim
What is the treatment for meningitis caused by N. meningitidis?
- Pen G (DOC)
- Ceftriaxone (used more than Pen G d/t convenience)
- Chloramphenicol
- FQ
What is the treatment for meningitis caused by S. agalactiae?
- Pen G (DOC)
- Ceftriaxone
- Chloramphenicol
- Bactrim
What is the treatment for meningitis caused by L. monocytogenes?
- Ampicillin (DOC)
- Bactrim
- Linezolid
What are the risks and benefits of using adjunctive corticosteroid therapy in meningitis?
- significantly less hearing loss and other neurologic sequelae in some children receiving Dexamethasone
- may decrease antibiotic penetration
When should corticosteroid adjunctive therapy be given for meningitis?

before or at the same time as the first dose of antibiotics (prevents increased inflammation d/t toxin release from cell lysis of first dose of ABX)
What is the prophylaxis for S. pneumoniae meningitis?
- Vaccination
- NO chemoprophylaxis
What is the prophylaxis for H. influenzae meningitis?
- Chemoprophylaxis:
- Rifampin
- FQ + Ceftriaxone
- Vaccination
What is the prophylaxis for N. meningitidis meningitis?
- Chemoprophylaxis:
- Rifampin
- FQ + Ceftriaxone
- Vaccination
What are the possible causes of aseptic meningitis?
- viral meningitis/encephalitis
- Mycobacterial meningitis
- Fungal meningitis
- Helminth diseases
- Chemically induced (NSAIDs - Ibuprofen #1, various chemotherapeutics)
What is the treatment for brain abscess?
- surgery
- Metronidazole
- Chloramphenicol

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giddyupp

63936

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CNS Infections

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CNS Infections

Updated

2011-02-04T16:47:00Z

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