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| ==Overview== | | ==Overview== |
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| ==Bacterial meningitis== | | ==Medical Therapy== |
| Bacterial meningitis is a [[medical emergency]] and has a high mortality rate if untreated.<ref name=Beckham_2006>{{cite journal |author=Beckham J, Tyler K |title=Initial Management of Acute Bacterial Meningitis in Adults: Summary of IDSA Guidelines |journal=Rev Neurol Dis |volume=3 |issue=2 |pages=57-60 |year=2006 |pmid=16819421}}</ref> All suspected cases, however mild, need emergency medical attention. Empiric antibiotics must be started immediately, even before the results of the [[lumbar puncture]] and [[Cerebrospinal fluid|CSF]] analysis are known. Antibiotics started within 4 hours of lumbar puncture will not significantly affect lab results. Adjuvant treatment with [[corticosteroids]] reduces rates of mortality, severe hearing loss and neurological sequelae.<ref>{{cite journal |author=van de Beek D, de Gans J, McIntyre P, Prasad K |title=Corticosteroids for acute bacterial meningitis |journal=Cochrane database of systematic reviews (Online) |volume= |issue=1 |pages=CD004405 |year=2007 |pmid=17253505 |doi=10.1002/14651858.CD004405.pub2}}</ref>
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| {| class = "prettytable" style = "float:right; font-size:85%; margin-left:15px"
| | ===Empiric Treatment=== |
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| ! Age group
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| ! Causes
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| | [[Neonate]]s
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| | Group B Streptococci, ''[[Escherichia coli]]'', ''[[Listeria monocytogenes]]''
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| | Infants
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| | ''[[Neisseria meningitidis]]'', ''[[Haemophilus influenzae]]'', ''[[Streptococcus pneumoniae]]''
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| | Children
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| |''N. meningitidis'', ''S. pneumoniae''
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| | Adults
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| | ''S. pneumoniae'', ''N. meningitidis'', Mycobacteria, Cryptococci
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| ===Pharmacotherapy=== | | ===Pathogen Specific Treatment=== |
| The choice of antibiotic depends on local advice. In most of the developed world, the most common organisms involved are ''[[Streptococcus pneumoniae]]'' and ''[[Neisseria meningitidis]]'': first line treatment in the UK is a third-generation [[cephalosporin]] (such as [[ceftriaxone]] or [[cefotaxime]]). In those under 3 years of age, over 50 years of age, or immunocompromised, [[ampicillin]] should be added to cover ''[[Listeria monocytogenes]]''. In the U.S. and other countries with high levels of penicillin resistance, the first line choice of antibiotics is [[vancomycin]] and a [[carbapenem]] (such as [[meropenem]]). In sub-Saharan Africa, oily [[chloramphenicol]] or [[ceftriaxone]] are often used because only a single dose is needed in most cases.
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| Staphylococci and gram-negative bacilli are common infective agents in patients who have just had a neurosurgical procedure. Again, the choice of antibiotic depends on local patterns of infection: [[cefotaxime]] and [[ceftriaxone]] remain good choices in many situations, but [[ceftazidime]] is used when ''[[Pseudomonas aeruginosa]]'' is a problem, and intraventricular [[vancomycin]] is used for those patients with intraventricular shunts because of high rates of [[Staphylococcus|staphylococcal]] infection. In patients with intracerebral prosthetic material (metal plates, electrodes or implants, etc.) then sometimes [[chloramphenicol]] is the only antibiotic that will adequately cover infection by ''[[Staphylococcus aureus]]'' (cephalosporins and carbapenems are inadequate under these circumstances).
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| Once the results of the CSF analysis are known along with the Gram-stain and culture, empiric therapy may be switched to therapy targeted to the specific causative organism and its sensitivities.
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| *''[[Neisseria meningitidis]]'' (Meningococcus) can usually be treated with a 7-day course of IV antibiotics:
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| **Penicillin-sensitive -- [[penicillin]] G or [[ampicillin]]
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| **Penicillin-resistant -- [[ceftriaxone]] or [[cefotaxime]]
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| **Prophylaxis for close contacts (contact with oral secretions) -- [[rifampin]] 600 mg bid for 2 days ''(adults)'' or 10 mg/kg bid ''(children)''. Rifampin is not recommended in pregnancy and as such, these patients should be treated with single doses of [[ciprofloxacin]], [[azithromycin]], or [[ceftriaxone]]
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| *''[[Streptococcus pneumoniae]]'' (Pneumococcus) can usually be treated with a 2-week course of IV antibiotics:
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| **Penicillin-sensitive -- [[penicillin]] G
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| **Penicillin-intermediate -- [[ceftriaxone]] or [[cefotaxime]]
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| **Penicillin-resistant -- [[ceftriaxone]] or [[cefotaxime]] + [[vancomycin]]
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| *''[[Listeria monocytogenes]]'' is treated with a 3-week course of IV [[ampicillin]] + [[gentamicin]].
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| *Gram negative bacilli -- [[ceftriaxone]] or [[cefotaxime]]
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| *''[[Pseudomonas aeruginosa]]'' -- [[ceftazidime]]''
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| *''[[Staphylococcus aureus]]''
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| **Methicillin-sensitive -- [[nafcillin]]
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| **Methicillin-resistant -- [[vancomycin]]
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| *''[[Streptococcus agalactiae]]'' -- [[penicillin]] G or [[ampicillin]]
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| *''[[Haemophilus influenzae]]'' -- [[ceftriaxone]] or [[cefotaxime]]
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| ==EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults.<ref name="pmid17278083">{{cite journal |author=Mandell LA, Wunderink RG, Anzueto A, Bartlett JG, Campbell GD, Dean NC, Dowell SF, File TM, Musher DM, Niederman MS, Torres A, Whitney CG |title=Infectious Diseases Society of America/American Thoracic Society consensus guidelines on the management of community-acquired pneumonia in adults |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=44 Suppl 2 |issue= |pages=S27–72 |year=2007 |month=March |pmid=17278083 |doi=10.1086/511159 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=17278083 |accessdate=2012-09-06}}</ref> (DO NOT EDIT)==
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| ==Viral meningitis==
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| ===Pharmacotherapy===
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| Unlike bacteria, viruses cannot be killed by antibiotics. Patients with very mild viral meningitis may only have to spend a few hours in a hospital, while those who have a more serious infection may be hospitalised for many more days for supportive care. Patients with mild cases, which often cause only flu-like symptoms, may be treated with fluids, bed rest (preferably in a quiet, dark room), and analgesics for pain and fever. Serious cases, especially in the case of young children or neonates, may require the use of antiviral drugs, such as [[acyclovir]]. The physician may also prescribe [[anticonvulsant]]s such as [[phenytoin]] to prevent [[seizure]]s and [[corticosteroid]]s to reduce brain inflammation. If inflammation is severe, pain medicine and sedatives may be prescribed to make the patient more comfortable.
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| ==Fungal meningitis==
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| This form of meningitis is rare in otherwise healthy people, but is a higher risk in those who have [[AIDS]], other forms of [[immunodeficiency]] (an immune system that does not respond adequately to infections) and [[immunosuppression]] (immune system malfunction as a result of medical treatment). In AIDS, ''[[Cryptococcus neoformans]]'' is the most common cause of fungal meningitis; it requires Indian ink staining of the CSF sample for identification of this capsulated yeast.
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| ===Pharmacotherapy===
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| Fungal meningitis is treated with long courses of highly dosed [[Antifungal drug|antifungals]].<ref>{{cite journal |author=Gottfredsson M, Perfect JR |title=Fungal meningitis |journal=Seminars in neurology |volume=20 |issue=3 |pages=307-22 |year=2000 |pmid=11051295 |doi=}}</ref>
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| ==References== | | ==References== |