Questions and Answers
To identify and eradicate the causative ______
organism
To prevent ______
complications
To prevent spread to ______
contacts
Treatment ______ include identifying the causative organism.
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One objective is to ______ the spread to contacts.
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Which antibiotic must be administered intravenously or deeply intramuscularly for seven to ten days?
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What is the alternative treatment regimen that combines Benzyl Penicillin and another drug, and how long should it be administered?
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How should the initial treatment for the recommended antibiotics be administered?
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For what duration is the combination of Ceftriaxone and Vancomycin administered?
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Which of the following medications is part of an alternative treatment regimen with Benzyl Penicillin?
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The combination of Clindamycin plus ______ is an alternative treatment for penicillin allergy.
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An alternative treatment regimen includes Cefotaxime and ______.
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[Blank] combined with Chloramphenicol is used as an alternative for those with penicillin allergies.
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Patients allergic to penicillin can be treated with Clindamycin plus Chloramphenicol or ______ and Vancomycin.
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For penicillin allergy, a treatment option is Cefotaxime and ______.
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For bacterial meningitis in adults under 50 years, the empirical treatment includes Ceftriaxone and ______.
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For adults over 50 years, Listeria is a suspected pathogen and the empirical treatment includes Ceftriaxone or Ampicillin and ______.
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For hospital-acquired bacterial meningitis, the empirical treatment includes Ceftazidime plus or minus ______.
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An alternative treatment for meningitis in adults under 50 years includes Meropenem or ______.
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Fluoroquinolone is an alternative treatment for bacterial meningitis in adults older than ______ years.
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Study Notes
Antibiotic Penetration
- Chloramphenicol, metronidazole, isoniazid, and pyrazinamide can penetrate the CSF even when the meninges are not inflamed
- β-lactam antibiotics, quinolones, and rifampicin can only penetrate the CSF when the meninges are inflamed
- Aminoglycosides, vancomycin, and erythromycin poorly penetrate the CSF under all circumstances
Goals of Management
- Rapid administration of a bactericidal antibiotic with good CNS penetration is necessary to treat neurologic infections
- Good tissue penetration is required to treat possible extra-CNS sources
- Anti-inflammatory agents should be used to suppress complications of bacterial lysis
Treatment Objectives
- Identify and eradicate the causative organism
- Prevent complications
- Prevent spread to contacts
Antibiotic Penetration in the CSF
- Chloramphenicol, metronidazole, isoniazid, and pyrazinamide can penetrate the CSF even when the meninges are not inflamed.
- β-lactam antibiotics, quinolones, and rifampicin can only penetrate the CSF when the meninges are inflamed.
- Aminoglycosides, vancomycin, and erythromycin have poor penetration into the CSF under all circumstances.
Goals of Management for Neurological Infections
- Rapid administration of a bactericidal antibiotic with good CNS penetration is essential to treat neurological infections.
- Antibiotics with good tissue penetration are necessary to treat possible extra-CNS sources of infection.
- Anti-inflammatory agents can help suppress complications resulting from bacterial lysis.
Treatment Objectives
- Identify and eradicate the causative organism.
- Prevent complications.
- Prevent the spread of infection to contacts.
Treatment Options
- Cetriaxone IV/deep IM for 7-10 days, or Vancomycin IV (Evidence Rating A).
- Alternative treatment: Benzyl Penicillin IV plus Chloramphenicol for 14 days (Evidence Rating A).
- All treatment should be administered intravenously initially.
Antibiotic Penetration in CSF
- Chloramphenicol, metronidazole, isoniazid, and pyrazinamide penetrate the CSF when the meninges are not inflamed
- β-lactam antibiotics, quinolones, and rifampicin penetrate the CSF only when the meninges are inflamed
- Aminoglycosides, vancomycin, and erythromycin poorly penetrate the CSF under all circumstances
Goals of Management for Neurological Infections
- Rapid administration of bactericidal antibiotics with good CNS penetration to treat neurologic infections and good tissue penetration to treat extra-CNS sources
- Use of anti-inflammatory agents to suppress complications of bacterial lysis
Treatment Objectives
- Identify and eradicate the causative organism
- Prevent complications
- Prevent spread to contacts
Treatment Options
- Cetriaxone IV/deep IM (7-10 days) and Vancomycin IV
- Alternative: Benzyl Penicillin IV plus Chloramphenicol (14 days)
- All treatment should be intravenous initially
Penicillin Allergy Management
- Clindamycin plus Chloramphenicol
- Or Cefotaxime and Vancomycin
Empirical Antibiotic Therapy for Suspected Bacterial Meningitis in Adults
Age-Related Empirical Treatment
-
For adults < 50 years old:
-
Most common pathogens are Meningococcus, Pneumococcus, Haemophilus Influenza
-
Empirical treatment is Ceftriaxone and Vancomycin
-
Alternative options for specialist care include Meropenem, Chloramphenicol, and Fluoroquinolones
-
For adults > 50 years old:
-
Most common pathogens are Pneumococcus, Listeria, and Gram-Negative Bacilli
-
Empirical treatment is Ceftriaxone or Ampicillin and Vancomycin
-
Alternative option for specialist care is Fluoroquinolone
Hospital-Acquired Meningitis
- Most common pathogens are Staphylococci, Gram-Negative Bacilli, and Pneumococcus
- Empirical treatment is Ceftazidime with or without Gentamycin
- Alternative option for specialist care is Meropenem
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Description
Learn about the three categories of antibiotics based on their ability to penetrate the cerebrospinal fluid (CSF), including when the meninges are inflamed or not.
