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Community-Acquired Bacterial Meningitis - #PHARMFAX

Roughly 50% of patients with bacterial meningitis have disabling neuropsychological deficits.

 

Roughly 50% of patients with bacterial meningitis have disabling neuropsychological deficits. Bacterial meningitis is an infection causing inflammation of the meninges.

Symptoms may present with fever, headache, nick stuffness, and visual changes. Empiric therapies are specific to age and high risk organisms, which I’ve listed in the table above with respective treatment duration.

Organisms for community-acquired pneumoniae include Streptococcus pneumoniae and agalactiae, N meningitidis, Listeria,and E. coli. Patients less than a month old commonly receive ampicillin and gentamicin. Avoid ceftriaxone in this age group because of biliary sludging.

Those who are more than 1 month to 50 years old get vancomycin and ceftriaxone. Streptococcus pneumoniae and N. meniningitis are the more common culprits. Vancomycin is for resistant S. pneumo, not MRSA for community associated presentations. For those 50 years and older, we also include ampicillin to this regimen to cover for Listeria.

The Neurocritical Care Society Cerebral Edema Guidelines recommends dexamethasone 10 mg IV prior to antimicrobials to mitigiate neurologic sequelae, including hearing loss. We want higher end of dosing range for BBB penetration; vancomycin 20 mg/kg, ceftriaxone 2gms, ampicillin 2gm for adults. piperacillin-tazobactam is not indicated for CNS infections due to poor BBB concentraitons. What about viral encephalitis? For more PHARMFAX in the drug bank, watch another video on my page, share the PHARMFAX with a friend, and I hope you learned something new.

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