Meningitis

Question 1

empiric therapy for meningitis

Answer 1

Ceftriaxone +/- ampicillin (listeria coverage) +/- vancomycin

Question 2

common bacterial causes of menigitis

Answer 2

B strep (S. agalactiae + Streptococcus pneumoniae), Listeria monocytogenes, Escherichia coli, Neisseria meningitidis

Question 3

Culture directed therapy for meninges

Answer 3

IV Penicillin G MU Q4H or IV ampicillin 2g Q4H

if pen all,
Streptococcus pneumoniae: Ceftriaxone 2g Q12H, If cephalosporin resistant: vancomycin + rifampicin 300mg Q12H x 10-14d

Neisseria meningitidis: Ceftriaxone 2g q12h x 5-7d

Listeria monocytogenes: cotrimoxazole, meropenem 2g q8h x >21d

Group B strep: Ceftriaxone 2g Q12H x 14-21d

Question 4

when to use adj corticosteroid therapy?

Answer 4

less hearing loss and other neurologic sequelae if H. influenza and S. pneumoniae meningitis

dexamethasone 10mg Q6H up to 4d

Question 5

Chemoprophylaxis for meningitis

Answer 5

Rifampicin
Infant(<1m): 5mg/kg Q12H , four doses
Children: 10mg/kg Q12H , four doses
Adult: 600mg Q12H , four doses

PO ciprofloxacin 500mg, one dose

IM ceftriaxone 125-250mg, one dose