Meningitis medical therapy: Difference between revisions
Line 13: | Line 13: | ||
* Empiric antibiotic treatment should be started within 30 minutes after the patient presentation. | * Empiric antibiotic treatment should be started within 30 minutes after the patient presentation. | ||
* In case of high suspicion of pneumococcal meningitis in adult patients, 0.15 mg/kg IV Q6H dexomethasone should be administered for 2 to 4 days. | * In case of high suspicion of pneumococcal meningitis in adult patients, 0.15 mg/kg IV Q6H dexomethasone should be administered for 2 to 4 days. | ||
** The first dose of | ** The first dose of dexomethasone is given along with or 20 minutes prior to starting the antibiotics treatment. | ||
;Shown below is a table summarizing the preferred and alternative empiric treatment for meningitis.<ref name="pmid15494903">{{cite journal |author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ |title=Practice guidelines for the management of bacterial meningitis |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=39 |issue=9 |pages=1267–84 |year=2004 |month=November |pmid=15494903 |doi=10.1086/425368 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=15494903 |accessdate=2012-11-28}}</ref> | ;Shown below is a table summarizing the preferred and alternative empiric treatment for meningitis.<ref name="pmid15494903">{{cite journal |author=Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ |title=Practice guidelines for the management of bacterial meningitis |journal=[[Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America]] |volume=39 |issue=9 |pages=1267–84 |year=2004 |month=November |pmid=15494903 |doi=10.1086/425368 |url=http://www.cid.oxfordjournals.org/cgi/pmidlookup?view=long&pmid=15494903 |accessdate=2012-11-28}}</ref> |
Revision as of 18:34, 21 March 2013
Meningitis Main Page |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [2]
Medical Therapy
Pharmacotherapy
Emperic Treatment
- Do not wait for the results of the CT scan and the lumbar puncture; empiric treatment should be started as soon as possible.
- Blood cultures should be drawn before starting the antibiotic therapy, and then the antibiotic treatment should be changed once the blood culture results are out.
- Empiric antibiotic treatment should be started within 30 minutes after the patient presentation.
- In case of high suspicion of pneumococcal meningitis in adult patients, 0.15 mg/kg IV Q6H dexomethasone should be administered for 2 to 4 days.
- The first dose of dexomethasone is given along with or 20 minutes prior to starting the antibiotics treatment.
- Shown below is a table summarizing the preferred and alternative empiric treatment for meningitis.[1]
Characteristics of the Patient | Possible Pathogens | Preferred Treatment | Duration of Treatment | Alternative Treatment |
Immunocompentent patient
Age<50 |
Streptococcus pneumonia,
Nisseria meningitis, Hemophilus influenzae |
Vancomycin
Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Ceftriaxone 2 g IV Q12H |
Stop or adjust treatment choice and duration when the results of the lumbar puncture are out | In case of penicillin allergy:
Chloramphenicol + Vancomycin |
Immunocompentent patient
Age>50 |
Streptococcus pneumonia,
Listeria, Nisseria meningitis, Group B streptococci, Hemophilus influenzae |
Vancomycin
Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Ceftriaxone 2 g IV Q12H + Ampicillin 2 g IV Q4H |
Stop or adjust treatment choice and duration when the results of the lumbar puncture are out | In case of penicillin allergy:
Chloramphenicol + Vancomycin + TMP/SMX |
Immunocompromised patient | Streptococcus pneumonia,
Nisseria meningitis, Hemophilus influenzae, Listeria, (Gram-negatives) |
Vancomycin
Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Cefepime 2 g IV Q8H + Ampicillin 2 g IV Q4H |
Stop or adjust treatment choice and duration when the results of the lumbar puncture are out | In case of penicillin allergy:
Vancomycin + TMP/SMX + Ciprofloxacin |
Patient with history of penetrating head trauma or neurosurgery | Streptococcus pneumonia (if CSF leak),
Hemophilus influenzae, Staphylococci, (Gram-negatives) |
Vancomycin
Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Cefepime 2 g IV Q8H |
Stop or adjust treatment choice and duration when the results of the lumbar puncture are out | In case of penicillin allergy:
Vancomycin + Ciprofloxacin |
Shunt infection | Streptococcus aureus,
Coagulase negative staphylococci, Gram-negatives (rare) |
Vancomycin
Loading dose:25-35 mg/kg, then 15-20 mg/kg Q8-12H Trough concentration: 20mcg/mL + Cefepime 2 g IV Q8H |
Stop or adjust treatment choice and duration when the results of the lumbar puncture are out | In case of penicillin allergy:
Vancomycin + Ciprofloxacin |
References
- ↑ Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM, Whitley RJ (2004). "Practice guidelines for the management of bacterial meningitis". Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America. 39 (9): 1267–84. doi:10.1086/425368. PMID 15494903. Retrieved 2012-11-28. Unknown parameter
|month=
ignored (help)