Sandbox/v31: Difference between revisions
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==Overview== | ==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]] | * 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, | * 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. | * 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.<ref name="pmid16394301">van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16394301 Community-acquired bacterial meningitis in adults.] ''N Engl J Med'' 354 (1):44-53. [http://dx.doi.org/10.1056/NEJMra052116 DOI:10.1056/NEJMra052116] PMID: [http://pubmed.gov/16394301 16394301]</ref><ref name="pmid20417414">Edmond K, Clark A, Korczak VS, | ** The first dose of dexomethasone is given along with or 20 minutes prior to starting the antibiotics treatment.<ref name="pmid16394301">van de Beek D, de Gans J, Tunkel AR, Wijdicks EF (2006) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=16394301 Community-acquired bacterial meningitis in adults.] ''N Engl J Med'' 354 (1):44-53. [http://dx.doi.org/10.1056/NEJMra052116 DOI:10.1056/NEJMra052116] PMID: [http://pubmed.gov/16394301 16394301]</ref><ref name="pmid20417414">Edmond K, Clark A, Korczak VS, S''PLUS''erson C, Griffiths UK, Rudan I (2010) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=20417414 Global ''PLUS'' regional risk of disabling sequelae from bacterial meningitis: a systematic review ''PLUS'' meta-analysis.] ''Lancet Infect Dis'' 10 (5):317-28. [http://dx.doi.org/10.1016/S1473-3099(10)70048-7 DOI:10.1016/S1473-3099(10)70048-7] PMID: [http://pubmed.gov/20417414 20417414]</ref><ref name="pmid15494903">Tunkel AR, Hartman BJ, Kaplan SL, Kaufman BA, Roos KL, Scheld WM et al. (2004) [http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&retmode=ref&cmd=prlinks&id=15494903 Practice guidelines for the management of bacterial meningitis.] ''Clin Infect Dis'' 39 (9):1267-84. [http://dx.doi.org/10.1086/425368 DOI:10.1086/425368] PMID: [http://pubmed.gov/15494903 15494903]</ref> | ||
==Empiric Therapy== | ==Empiric Therapy== | ||
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{| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" | {| class="wikitable mw-collapsible mw-collapsed" id="mw-customcollapsible-table01" | ||
|- | |- | ||
| valign=top | | | valign=top | | ||
{| style="margin: 0 0 0em 0em; border: | {| style="margin: 0 0 0em 0em; border: 0px solid #696969; float: left; cellpadding=0; cellspacing= 0; width: 32em; height: 50em;" | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Newborn, Age <1 Week}}'' | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Newborn, Age <1 Week}}'' | ||
|- | |- | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 100—150 mg/kg/day IV q8—12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 100—150 mg/kg/day IV q8—12h''''' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 50 mg/kg IV q8h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| 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''''' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 150—200 mg/kg/day IV q6—8h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 150—200 mg/kg/day IV q6—8h''''' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 200 mg/kg/day IV q6—8h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| 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''''' | ||
|- | |- | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Infant | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Infant ''PLUS'' Children}}''<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 | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <BR> to achieve serum trough concentrations of 15–20 μg/mL | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 15 mg/kg IV q6h''''' <BR> to achieve serum trough concentrations of 15–20 μg/mL | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 225—300 mg/kg/day IV q6–8h''''' <BR>''OR''<BR>▸'''''[[Ceftriaxone]] 80—100 mg/kg/day IV q12–24h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Cefotaxime]] 225—300 mg/kg/day IV q6–8h''''' <BR>''OR''<BR>▸'''''[[Ceftriaxone]] 80—100 mg/kg/day IV q12–24h''''' | ||
|- | |- | ||
|} | |} | ||
| valign=top | | | valign=top | | ||
{| style="margin: 0 0 0em 0em; border: | {| style="margin: 0 0 0em 0em; border: 0px solid #696969; float: left; cellpadding=0; cellspacing= 0; width: 32em; height: 50em;" | ||
! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult, Age <50 Years}}<sup>†</sup>'' | ! style="padding: 0 5px; font-size: 100%; background: #F8F8FF" align=center | ''{{fontcolor|#6C7B8B|Adult, Age <50 Years}}<sup>†</sup>'' | ||
|- | |- | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h''''' <BR> to achieve serum trough concentrations of 15–20 μg/mL | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h''''' <BR> to achieve serum trough concentrations of 15–20 μg/mL | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| 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''''' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| 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''''' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30–60 mg/kg/day IV q8–12h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ampicillin]] 2 g IV q4h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| 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''''' | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| 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''''' | ||
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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> | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| 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'''''<BR><BR><BR> | | 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'''''<BR><BR><BR> | ||
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| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Vancomycin]] 30—60 mg/kg/day IV q8–12h''''' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ''PLUS'' | ||
|- | |- | ||
| style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8 h'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h''''' | | style="font-size: 80%; padding: 0 5px; background: #DCDCDC" align=left | ▸ '''''[[Ceftazidime]] 2 g IV q8 h'''''<BR>''OR''<BR>▸ '''''[[Cefepime]] 2 g IV q8h'''''<BR>''OR''<BR>▸ '''''[[Meropenem]] 2 g IV q8h''''' |
Revision as of 03:16, 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
|
|
†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
|
|
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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