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Digital PharmD

Informatics in Pharmacy

Meningitis

August 13, 2018 By Dr. G, PharmD

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Signs and Symptoms:

  • Brudzinski sign and Kernig Sign
  • Fever, altered mental status, neck, stiffness, seizures, neurological deficits

Treatment:

  • <1-month-old – ampicillin (listeria coverage) and cefotaxime or gent
    Common pathogens: Group B Strep, E. coli, K. pneumoniae, Enterobacter, Listeria monocytogenes
  • 1-23 months old – vancomycin and ceftriaxone or cefotaxime
    Common pathogens: S. pneumoniae, N. meningitidis, H. influenzae
  • 18-50 years –  vancomycin and ceftriaxone or cefotaxime
    Common pathogens: S. pneumoniae, N. meningitidis
  • 50+ or any age with predisposing conditions – vancomycin and ceftriaxone or cefotaxime + ampicillin
    Common pathogens:  S. pneumoniae, N. meningitidis, H. influenzae, Listeria monocytogenes
  • Cover pseudomonas in penetrating trauma, post-surgical and shunts: vancomycin and cefepime or meropenam
  • Dexamethasone: If used, administer the first dose within 10-20 minutes before or concomitant with first antimicrobial dose. Only continue if S. pneumonia, decreases complicaitions in peds especially.Who gets prophylaxis:
  • If H. influenzae or N. meningitidis, household contacts and direct contacts should get prophylaxis.
    • N. meningitidis
      • Rifampin 5-10 BID for 2 days in kids
      • Rifampin 600 mg BID for 2 days in adults
      • Ceftriaxone 125 mg IM times 1 < 15 years old
      • Ceftriaxone 250 mg IM times 1 >15 years old
      • Ciprofloxacin 20 mg/kg up to 500 mg times 1
    • H. influenzae
      • Rifampin 20 mg/kg per dose up to 600 mg times 4 days

Bactrim can replace ampicillin in penicillin allergy

Must Know:

***Remember always treat for S. pneumoniae, N. meningitidis, vanc, except in newborns + a cephalosporin), listeria for the old and young (ampicillin)***

Filed Under: Infectious Disease, Pediatrics

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acid base acidosis acute coronary syndrome alkalosis analgesics anaphylaxis aortic dissection arrhythmia bcps Beta-Blockers biostatistics blood pressure cardiac markers CHA2DS2-VasC cocaine COVID-19 diabetes diabetes inspidius heart failure Heparin hypersensitivity hypertension hypovolemic shock intubation ionotropes journal club lipids LMWH medication safety morphine conversions myocardial infarction needs work NOAC NSTEMI obstructive shock pharmacoeconomics pheochromocytoma pressors reference materials right mi sedation septic shock shock STEMI Updated 2020