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Questions and Answers
Which type of antibiotics generally penetrate the CSF only when the meninges are inflamed?
Which type of antibiotics generally penetrate the CSF only when the meninges are inflamed?
- Vancomycin
- Chloramphenicol
- Aminoglycosides (correct)
- Metronidazole
What is the most important consideration for the choice of empiric antibiotic treatment in acute bacterial meningitis?
What is the most important consideration for the choice of empiric antibiotic treatment in acute bacterial meningitis?
- Availability of antibiotics in the region
- Regional rate of decreased susceptibility to penicillin (correct)
- Type of bacteria causing meningitis
- Patient's gender
Which antibiotic can penetrate the CSF even when the meninges are not inflamed?
Which antibiotic can penetrate the CSF even when the meninges are not inflamed?
- Isoniazid (correct)
- Rifampicin
- Quinolones
- Vancomycin
What is the primary action required for acute bacterial meningitis?
What is the primary action required for acute bacterial meningitis?
Which type of antibiotics generally penetrate the CSF poorly under all circumstances?
Which type of antibiotics generally penetrate the CSF poorly under all circumstances?
Which category of antibiotics can generally penetrate the CSF when the meninges are inflamed and used in high doses?
Which category of antibiotics can generally penetrate the CSF when the meninges are inflamed and used in high doses?
What is the major indication for Ampicillin and Amoxicillin in the treatment of bacterial meningitis?
What is the major indication for Ampicillin and Amoxicillin in the treatment of bacterial meningitis?
Why is vancomycin indicated in the treatment of bacterial meningitis?
Why is vancomycin indicated in the treatment of bacterial meningitis?
Which antibiotic is recommended as the first-line empiric therapy in the treatment of bacterial meningitis?
Which antibiotic is recommended as the first-line empiric therapy in the treatment of bacterial meningitis?
What is the main reason behind the recommendation to avoid using tetracyclines in the treatment of bacterial meningitis?
What is the main reason behind the recommendation to avoid using tetracyclines in the treatment of bacterial meningitis?
What is the mode of action (MOA) of chloramphenicol in the treatment of bacterial meningitis?
What is the mode of action (MOA) of chloramphenicol in the treatment of bacterial meningitis?
Why should aminoglycosides be combined with b-lactams or glycopeptides in the treatment of bacterial meningitis?
Why should aminoglycosides be combined with b-lactams or glycopeptides in the treatment of bacterial meningitis?
Which antibiotic has broad spectrum activity against Gram-positive and Gram-negative bacteria, anaerobes, and atypical organisms, and is well transmitted via blood to CSF?
Which antibiotic has broad spectrum activity against Gram-positive and Gram-negative bacteria, anaerobes, and atypical organisms, and is well transmitted via blood to CSF?
What is the main reason behind recommending vancomycin to be combined with b-lactams in the treatment of bacterial meningitis?
What is the main reason behind recommending vancomycin to be combined with b-lactams in the treatment of bacterial meningitis?
Why is moxifloxacin considered as the drug of choice in the treatment of bacterial meningitis?
Why is moxifloxacin considered as the drug of choice in the treatment of bacterial meningitis?
What is the mode of action (MOA) of Carbapenems in the treatment of bacterial meningitis?
What is the mode of action (MOA) of Carbapenems in the treatment of bacterial meningitis?
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Study Notes
Antibiotic Penetration in Meningitis
- Beta-lactam antibiotics generally penetrate the CSF only when the meninges are inflamed.
Empiric Antibiotic Treatment in Acute Bacterial Meningitis
- The most important consideration for the choice of empiric antibiotic treatment in acute bacterial meningitis is the patient's age.
Antibiotics and CSF Penetration
- Chloramphenicol can penetrate the CSF even when the meninges are not inflamed.
- Aminoglycosides generally penetrate the CSF poorly under all circumstances.
- Beta-lactam antibiotics can generally penetrate the CSF when the meninges are inflamed and used in high doses.
Primary Action Required in Acute Bacterial Meningitis
- The primary action required for acute bacterial meningitis is rapid initiation of empiric antibiotic treatment.
Indications for Antibiotics in Bacterial Meningitis
- Ampicillin and Amoxicillin are indicated for Listeria monocytogenes infections.
- Vancomycin is indicated due to the increased prevalence of pneumococcal resistance to beta-lactam antibiotics.
- Cefotaxime or Ceftriaxone are recommended as the first-line empiric therapy in the treatment of bacterial meningitis.
Contraindications and Precautions
- Tetracyclines are not recommended in the treatment of bacterial meningitis due to the risk of increased intracranial pressure.
- Aminoglycosides should be combined with beta-lactams or glycopeptides in the treatment of bacterial meningitis to reduce the risk of toxicity.
- Meropenem has broad spectrum activity against Gram-positive and Gram-negative bacteria, anaerobes, and atypical organisms, and is well transmitted via blood to CSF.
Mode of Action and Combination Therapy
- Chloramphenicol inhibits protein synthesis by binding to the 50S ribosomal subunit.
- Vancomycin should be combined with beta-lactams in the treatment of bacterial meningitis to provide synergistic activity against Streptococcus pneumoniae.
- Moxifloxacin is not considered the drug of choice in the treatment of bacterial meningitis due to concerns about resistance and CNS toxicity.
- Carbapenems inhibit bacterial cell wall formation by binding to the penicillin-binding protein.
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