Sandbox john

Multiple Tables

• 1.

Unfavorable Prognostic Factors

▸  Presenting with encephalopathy or coma

▸  Younger than 10 years or elderly

▸  Late start of antibiotics

▸  Sterile cultures

Favorable prognostic factors

▸  Craniotomy instead of burr holes as surgical procedure

▸  Early treatment

▸  Young age (optimal between 10-20 years)

▸  Patient presents awake, alert and oriented

▸  Source of infection: paranasal sinuses

▸  Aerobic streptococci isolated in culture

▸  Aerobic streptococci as single pathogen

• 2.

Unfavorable Prognostic Factors
▸  Presenting with encephalopathy or coma
▸  Younger than 10 years or elderly
▸  Late start of antibiotics
▸  Sterile cultures
Favorable Prognostic Factors
▸  Craniotomy instead of burr holes as surgical procedure
▸  Early treatment
▸  Young age (optimal between 10-20 years)
▸  Patient presents awake, alert and oriented
▸  Source of infection: paranasal sinuses
▸  Aerobic streptococci isolated in culture
▸  Aerobic streptococci as single pathogen

• 3.

Cardiovascular	No underlying causes
Chemical/Poisoning	No underlying causes
Dental	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	No underlying causes
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	No underlying causes
Genetic	No underlying causes
Hematologic	No underlying causes
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal/Orthopedic	No underlying causes
Neurologic	No underlying causes
Nutritional/Metabolic	No underlying causes
Obstetric/Gynecologic	No underlying causes
Oncologic	No underlying causes
Ophthalmologic	No underlying causes
Overdose/Toxicity	No underlying causes
Psychiatric	No underlying causes
Pulmonary	No underlying causes
Renal/Electrolyte	No underlying causes
Rheumatology/Immunology/Allergy	No underlying causes
Sexual	No underlying causes
Trauma	No underlying causes
Urologic	No underlying causes
Miscellaneous	No underlying causes

Play Time

Pathogen-Based Therapy   ▸  Neisseria meningitidis   ▸  Streptococcus pneumoniae   ▸  Gram negative bacilli   ▸  Pseudomonas aeruginosa   ▸  Staphylococci   ▸  Listeria monocytogenes   ▸  Haemophilus influenzae   ▸  Streptococcus agalactiae   ▸  Bacteroides fragilis   ▸  Fusobacterium spp.

Infants < 1 month Preferred Regimen ▸ Ampicillin 200 mg/kg/day IV, q4h PLUS ▸ Cefotaxime 200 mg/kg/day IV, q6h Infants 1-3 months Preferred Regimen ▸ Ampicillin 200 mg/kg/day IV, q4h PLUS ▸ Cefotaxime 200 mg/kg/day IV, q6h OR ▸ Ceftriaxone 100 mg/kg/day IV, q12h > 3 months Immunocompetent Children; Adults < 55 years† Preferred Regimen ▸ Vancomycin Child: 60 mg/kg/day IV, q6h; Adult: 2 g/day IV, q12h PLUS ▸ Cefotaxime Child: 200 mg/kg/day IV, q6h; Adult: 12 g/day IV, q4h OR ▸ Ceftriaxone Child: 100 mg/kg/day IV, q12h; Adult: 4 g/day IV, q12h OR ▸ Cefepime Child: 150 mg/kg/day IV, q8h; Adult: 6 g/day IV, q8h † Might be added Metronidazole Child: 30 mg/kg/day, q6h; Adult: 1500-2000 mg/day, q6h Adults > 55 years; Alcoholics; Debilitating Illness Preferred Regimen ▸ Ampicillin Child: 200 mg/kg/day IV, q4h; Adult: 12 g/day IV, q4h PLUS ▸ Vancomycin Child: 60 mg/kg/day IV, q6h; Adult: 2 g/day IV, q12h PLUS ▸ Cefotaxime Child: 200 mg/kg/day IV, q6h; Adult: 12 g/day IV, q4h OR ▸ Ceftriaxone Child: 100 mg/kg/day IV, q12h; Adult: 4 g/day IV, q12h OR ▸ Cefepime Child: 150 mg/kg/day IV, q8h; Adult: 6 g/day IV, q8h Specific Situations† Preferred Regimen ▸ Ampicillin Child: 200 mg/kg/day IV, q4h; Adult: 12 g/day IV, q4h PLUS ▸ Vancomycin Child: 60 mg/kg/day IV, q6h; Adult: 2 g/day IV, q12h PLUS ▸ Ceftazidime Child: 150 mg/kg/day IV, q8h; Adult: 6 g/day IV, q8h OR ▸ Meropenem Child: 120 mg/kg/day IV, q8h; Adult: 3 g/day IV, q8h † Hospital Acquired Meningitis; Posttraumatic Meningitis; Postneurosurgery   Meningitis; Neutropenia; Impaired Cell-mediated Immunity