Sandbox/20: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
{{CMG}} | {{CMG}} | ||
==Definition== | ==Definition== | ||
* [[Bacterial meningitis]] is the infection of [[meninges]] by [[bacteria]]. | |||
==Empiric Therapy== | ==Empiric Therapy== | ||
===Negative CSF Gram Stain=== | ====Negative CSF Gram Stain==== | ||
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|style="width:35%"|'''Alternative Regimen''' | |style="width:35%"|'''Alternative Regimen''' | ||
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| '''''Preterm—1 mo''''' || '''''[[Streptococcus agalactiae]]''''' (49%) <BR> '''''[[Escherichia coli]]''''' (18%) <BR> '''''misc. Gram-positive''''' (10%) <BR> '''''misc. Gram-negative''''' (10%) <BR> '''''[[Listeria]]''''' (7%) || '''''Drug A''''' <BR> ''PLUS'' <BR> '''''Drug B''''' || '''''Drug C''''' <BR> ''PLUS'' <BR> '''''Drug D''''' | | '''''Preterm—1 mo''''' || '''''[[Streptococcus agalactiae]]''''' (49%) <BR> '''''[[Escherichia coli]]''''' (18%) <BR> '''''misc. Gram-positive''''' (10%) <BR> '''''misc. Gram-negative''''' (10%) <BR> '''''[[Listeria]]''''' (7%) || '''''Drug A''''' <BR> ''PLUS'' <BR> '''''Drug B''''' || '''''Drug C''''' <BR> ''PLUS'' <BR> '''''Drug D''''' | ||
|- | |- | ||
| '''''1 mo—50 yrs''''' || '''''[[Streptococcus pneumoniae]] <BR> [[Neisseria meningitidis]] <BR> [[Haemophilus influenzae]]<sup>†</sup> || '''''[[Cefotaxime]] 2 gm IV q4—6h''''' ''OR'' '''''[[Ceftriaxone]] 2 gm IV q12h''''' <BR> ''PLUS'' <BR> '''''[[Vancomycin]] 500—750 mg IV q6h'''''<sup>‡</sup> <BR> ''PLUS'' <BR> '''''[[Dexamethasone]]''''' || | | '''''1 mo—50 yrs''''' || '''''[[Streptococcus pneumoniae]] <BR> [[Neisseria meningitidis]] <BR> [[Haemophilus influenzae]]<sup>†</sup> || '''''[[Cefotaxime]] 2 gm IV q4—6h''''' ''OR'' '''''[[Ceftriaxone]] 2 gm IV q12h''''' <BR> ''PLUS'' <BR> '''''[[Vancomycin]] 500—750 mg IV q6h'''''<sup>‡</sup> <BR> ''PLUS'' <BR> '''''[[Dexamethasone]]''''' || | ||
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<sup>†</sup> H. influenzae now very rare, listeria unlikely if young & immuno-competent (add ampicillin if suspect listeria: 2 gm IV q4h) | <sup>†</sup> H. influenzae now very rare, listeria unlikely if young & immuno-competent (add ampicillin if suspect listeria: 2 gm IV q4h) | ||
<sup>‡</sup> Children’s dosage 15 mg/kg IV q6h (2x standard adult dose) | <sup>‡</sup> Children’s dosage 15 mg/kg IV q6h (2x standard adult dose) | ||
===Positive CSF Gram Stain=== | |||
====Positive CSF Gram Stain==== | |||
==Pathogen-Specific Therapy== | ==Pathogen-Specific Therapy== | ||
Revision as of 22:56, 12 December 2013
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Definition
- Bacterial meningitis is the infection of meninges by bacteria.
Empiric Therapy
Negative CSF Gram Stain
| Group | Etiology | Preferred Regimen | Alternative Regimen |
| Preterm—1 mo | Streptococcus agalactiae (49%) Escherichia coli (18%) misc. Gram-positive (10%) misc. Gram-negative (10%) Listeria (7%) |
Drug A PLUS Drug B |
Drug C PLUS Drug D |
| 1 mo—50 yrs | Streptococcus pneumoniae Neisseria meningitidis Haemophilus influenzae† |
Cefotaxime 2 gm IV q4—6h OR Ceftriaxone 2 gm IV q12h PLUS Vancomycin 500—750 mg IV q6h‡ PLUS Dexamethasone |
† H. influenzae now very rare, listeria unlikely if young & immuno-competent (add ampicillin if suspect listeria: 2 gm IV q4h)
‡ Children’s dosage 15 mg/kg IV q6h (2x standard adult dose)