Meningitis

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)***