Sandbox/v31: Difference between revisions
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====Community-Acquired Meningitis==== | ====Community-Acquired Meningitis==== | ||
<br> | |||
<div class="mw-customtoggle-table01" style="width: 300px;"> ▸ <font color="#1f4099"><BIG>'''Newborn, Age <1 Week'''</BIG></font></div> | <div class="mw-customtoggle-table01" style="width: 300px;"> ▸ <font color="#1f4099"><BIG>'''Newborn, Age <1 Week'''</BIG></font></div> | ||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" | {| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q12h''''' | ||
|} | |} | ||
|} | |} | ||
<div class="mw-customtoggle-table02" style="width: 300px;"> ▸ <font color="#1f4099"><BIG>'''Newborn, Age 1—4 Weeks'''</BIG></font></div> | <div class="mw-customtoggle-table02" style="width: 300px;"> ▸ <font color="#1f4099"><BIG>'''Newborn, Age 1—4 Weeks'''</BIG></font></div> | ||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" | {| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table02" | ||
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{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;" | {| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;" | ||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Newborn, Age 1—4 Weeks}}'' | ! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Newborn, Age 1—4 Weeks}}'' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q8h''''' <BR> OR <BR> ▸'''''[[Tobramycin]]2.5 mg/kg IV q8h''''' <BR> OR <BR> ▸ '''''[[Amikacin]] 10 mg/kg IV q8h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Gentamicin]] 2.5 mg/kg IV q8h''''' <BR> OR <BR> ▸'''''[[Tobramycin]]2.5 mg/kg IV q8h''''' <BR> OR <BR> ▸ '''''[[Amikacin]] 10 mg/kg IV q8h''''' | ||
|} | |} | ||
|} | |} | ||
<div class="mw-customtoggle-table03" style="width: 300px;"> ▸ <font color="#1f4099"><BIG>'''Infant & Children'''</BIG></font></div> | |||
{| | {| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table03" | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Infant & Children}}'' | |- | ||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Infant & Children}}'' | |||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
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|- | |- | ||
|} | |} | ||
|} | |||
<div class="mw-customtoggle-table04" style="width: 300px;"> ▸ <font color="#1f4099"><BIG>'''Adult, Age <50 Years<sup>†</sup>'''</BIG></font></div> | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table04" | |||
|- | |||
| valign=top | | | valign=top | | ||
{| style="margin: 0 0 0em 0em; border: 0px | {| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;" | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult, Age <50 Years}}<sup>†</sup>'' | ! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult, Age <50 Years}}<sup>†</sup>'' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g IV q12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g IV q12h''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult, Age >50 Years}}'' | |} | ||
|} | |||
<div class="mw-customtoggle-table05" style="width: 300px;"> ▸ <font color="#1f4099"><BIG>'''Adult, Age >50 Years'''</BIG></font></div> | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table05" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult, Age >50 Years}}'' | |||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g IV q12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 8–12 g/day IV q4–6h'''''<BR> ''OR'' <BR>▸'''''[[Ceftriaxone]] 2 g IV q12h''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Immunocompromised}}'' | |} | ||
|} | |||
<div class="mw-customtoggle-table06" style="width: 300px;"> ▸ <font color="#1f4099"><BIG>'''Immunocompromised'''</BIG></font></div> | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table06" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Immunocompromised}}'' | |||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h''''' <BR> ''OR'' <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefepime]] 2 g IV q8h''''' <BR> ''OR'' <BR> ▸ '''''[[Meropenem]] 2 g IV q8h''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Recurrent}}'' | |} | ||
|} | |||
<div class="mw-customtoggle-table07" style="width: 300px;"> ▸ <font color="#1f4099"><BIG>'''Recurrent'''</BIG></font></div> | |||
{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table07" | |||
|- | |||
| valign=top | | |||
{| style="margin: 0 0 0em 0em; border: 0px; float: left; cellpadding=0; cellspacing= 0; width: 32em;" | |||
! style="padding: 0 5px; border: 0px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Recurrent}}'' | |||
|- | |- | ||
! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ! style="padding: 0 5px; font-size: 80%; background: #F5F5F5" align=left | ''Preferred Regimen'' | ||
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|} | |} | ||
<SMALL><sup>†</sup>Add '''''[[Ampicillin]] 2 g IV q4h''''' ('''''50 mg/kg IV q6h''''' for children) if meningitis caused by ''[[Listeria monocytogenes]]'' is also suspected.</SMALL> | <SMALL><sup>†</sup> Add '''''[[Ampicillin]] 2 g IV q4h''''' ('''''50 mg/kg IV q6h''''' for children) if meningitis caused by ''[[Listeria monocytogenes]]'' is also suspected.</SMALL> | ||
Revision as of 03:40, 20 January 2014
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], Sheng Shi, M.D. [3]
Overview
- If the suspected patient complaints with fever,headache,altered level of consciousness, signs of meningeal irritationthe, blood culture or CSF should be obtained urgently,then CT.But DO NOT wait for the results of the CT scan PLUS the lumbar puncture; empiric treatment should be started as soon as possible.
- Blood cultures should be drawn before starting the antibiotic therapy, PLUS 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.
Empiric Therapy
Community-Acquired Meningitis
▸ Newborn, Age <1 Week
|
▸ Newborn, Age 1—4 Weeks
|
▸ Infant & Children
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▸ Adult, Age <50 Years†
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▸ Adult, Age >50 Years
|
▸ Immunocompromised
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▸ Recurrent
|
† Add Ampicillin 2 g IV q4h (50 mg/kg IV q6h for children) if meningitis caused by Listeria monocytogenes is also suspected.
Healthcare-Associated Meningitis
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|
Adapted from Advances in treatment of bacterial meningitis. Lancet. 2012;380(9854):1693-702.[4]
References
- ↑ van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (2006) Community-acquired bacterial meningitis in adults. N Engl J Med 354 (1):44-53. DOI:10.1056/NEJMra052116 PMID: 16394301
- ↑ Edmond K, Clark A, Korczak VS, SPLUSerson C, Griffiths UK, Rudan I (2010) Global PLUS regional risk of disabling sequelae from bacterial meningitis: a systematic review PLUS meta-analysis. Lancet Infect Dis 10 (5):317-28. DOI:10.1016/S1473-3099(10)70048-7 PMID: 20417414
- ↑ Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) Practice guidelines for the management of bacterial meningitis. Clin Infect Dis 39 (9):1267-84. DOI:10.1086/425368 PMID: 15494903
- ↑ van de Beek, D.; Brouwer, MC.; Thwaites, GE.; Tunkel, AR. (2012). "Advances in treatment of bacterial meningitis". Lancet. 380 (9854): 1693–702. doi:10.1016/S0140-6736(12)61186-6. PMID 23141618. Unknown parameter
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