Gremlin: Bacterial Meningitis

Question 1

meningitis: most common organism in peds < 1 month AND empiric agents

Answer 1

• Group B strep
• E. coli
• listeria monocytogenes
• klebsiella spesces
  AGENTS
• ampicillin + (aminoglycoside or cefotaxime)
  - add on acyclovir if HSV suspected

prefer aminoglycoside, but if pt has renal dysfunctionor is predisposed, use cefotaxime

Question 2

meningitis: most common organism in peds 1-23 months and subsequent empiric treatment for age gorup

Answer 2

• s. pneumoniae
• neisseria meningitidiis
• H. influenzae
• E. coli

AGENTS
- vanco + (cefotaxime or ceftraixone)

prefer ceftraixone as it is dosed less frequently

Question 3

meningitis: most common organism in pts 2-50 yrs and subsequent empiric treatment for age gorup

Answer 3

• N. meningitidis
• S. pneumoniae
• AGENTS
• vanco + (cefotaxime or ceftraixone)

prefer ceftraixone as it is dosed less frequently

Question 4

neonate menigitis risk factors

Answer 4

• maternal GBS colonization
• preterm birth or LBW (<2.5kg)
• chorioamnionitis
• maternal endometriosis
• prolonged duration of intrauterine montiroing (>12 hrs)
• prolonged rupture of membnranes
• traumatic delivery
• UT abnormalities

risk factors primarily associated with the pregnancy and/or delivery

Question 5

children meningitis risk factors

Answer 5

• asplenia
• immunodeficiency (HIV)
• sickle cell anemia
• cochlear implant
• CSF leak
• recent URTI
• daycare attendence
• exposure to suspect pathogens
• penetrating head trauma
• lack of immunziations

primalriy looing at things that would affect the immune system

Question 6

infant s/s for infection in meningitis

Answer 6

• poor feeding
• vomiting
• fever/temp instabilities
• seizures (like 50% meningitis cases)
• irritability
• lethargy
• bulging fontanelle (meningitis specific?)

Question 7

children s/s of meningitis

Answer 7

• fever
• headache
• lethargy
• vomiting
• myalgia
• photophobia
• stiff neck
• seizure
• confusion

Question 8

bacterial meningitis dx

Answer 8

lumbar puncture and analysis of CSF
- eelvated WBC (less elevated in viral meningitis)
- elevated protein (WNL in viral)
- low glucose (WNL in viral)
- positive bacterial culture <- the actual dx

also obtain blood cultures to make sure blood is not ifnected

Question 9

vanco dosing guideliens

Answer 9

• children less than 12 may need a higher dose of vanco than those older than 12 d/t drug cleara nce
• AUC guided dosing: goal between 400 and 600
• if trough must be used aim for 7-10

Question 10

dexamethasone use in meningitis

Answer 10

• may be used in adjunct to ABX to decrease hearing loss in pts with H. influenz meningitis
  
  • if being used, must be admined within 10-20 min of abx admin, no benefit demonstrated if given 1hr after
• IDSA recs
  
  • NOT for neonates
  • H. influenzae: recommend if initiated before admin of abx
  • S. pneumoniae: consider if high risk mortality
  • gram neg: not recommended