Drug Treatment of Bacterial Meningitis Quiz

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.