Meningitis medical therapy: Difference between revisions

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* 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 [[dexomethasone]] is given along with or 20 minutes prior to starting the antibiotics treatment.
** 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

Patient Information

Overview

Causes

Classification

Viral Meningitis
Bacterial Meningitis
Fungal Meningitis

Differential Diagnosis

Diagnosis

Treatment

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

  1. 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)


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