[CP 181] Trans #2_Bacterial Meningitis
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65 Terms
1
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Strep. agalactiae, E. coli, Klebsiella pneumoniae, Enterobacter spp., Listeria monocytogenes
[EMPIRIC]
Less than 1 month old
Pathogens
Less than 1 month old
Pathogens
2
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Ampicillin + Cefotaxime OR Ampicillin + Aminoglycosides
[EMPIRIC]
Less than 1 month old
Antibiotics
Less than 1 month old
Antibiotics
3
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Streptococcus pneumoniae, Neisseria meningitidis, H. influenzae, S. agalactiae
[EMPIRIC]
1-23 months old
Pathogens
1-23 months old
Pathogens
4
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Vancomycin + 3rd gen cephalosporins (Cefotaxime or Ceftriaxone)
[EMPIRIC]
1-23 months old
Antibiotics
1-23 months old
Antibiotics
5
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Streptococcus pneumoniae, Neisseria meningitidis, H. influenzae
[EMPIRIC]
2-50 years old
Pathogens
2-50 years old
Pathogens
6
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Vancomycin + 3rd gen cephalosporins (Cefotaxime or Ceftriaxone)
[EMPIRIC]
2-50 years old
Antibiotics
2-50 years old
Antibiotics
7
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Neisseria meningitidis, Streptococcus pneumoniae, Listeria monocytogenes, E. coli, Klebsiella pneumoniae, Enterobacter spp.
[EMPIRIC]
More than 50 years old
Pathogens
More than 50 years old
Pathogens
8
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Ampicillin+ 3rd gen cephalosporin (Cefotaxime or Ceftriaxone) + Vancomycin
[EMPIRIC]
More than 50 years old
Antibiotics
More than 50 years old
Antibiotics
9
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Community Acquired Meningitis pathogens, Gram negative bacilli, Staphylococcus aureus, Coagulase-negative staphylococci, Propionibacterium acnes
[EMPIRIC]
Healthcare-associated meningitis
Pathogens
Healthcare-associated meningitis
Pathogens
10
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(Vancomycin or Linezolid) + (Ceftazidime or Cefepime) OR Meropenem
[EMPIRIC]
Healthcare-associated meningitis
Antibiotics
Healthcare-associated meningitis
Antibiotics
11
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10-14 days
[S. PNEUMONIAE]
Duration of Treatment
Duration of Treatment
12
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Penicillin G, Ampicillin
[S. PNEUMONIAE]
MIC < 0.1 mg/L
Standard Therapy
MIC < 0.1 mg/L
Standard Therapy
13
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Penicillin G: 4 m units, Q4
Ampicillin: 2g, Q4
Ampicillin: 2g, Q4
[S. PNEUMONIAE]
MIC < 0.1 mg/L
Standard Therapy
Dose and Frequency
MIC < 0.1 mg/L
Standard Therapy
Dose and Frequency
14
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Ceftriaxone, Cefotaxime
[S. PNEUMONIAE]
MIC < 0.1 mg/L
Alternative
MIC < 0.1 mg/L
Alternative
15
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Ceftriaxone: 2 g, Q12
Cefotaxime: 2 g, Q4
Cefotaxime: 2 g, Q4
[S. PNEUMONIAE]
MIC < 0.1 mg/L
Alternative
Dose and Frequency
MIC < 0.1 mg/L
Alternative
Dose and Frequency
16
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Chloramphenicol: 50-100 mg/kg/d, Q6
[S. PNEUMONIAE]
MIC < 0.1 mg/L
B-lactam allergy
Dose and Frequency
MIC < 0.1 mg/L
B-lactam allergy
Dose and Frequency
17
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Ceftriaxone, Cefotaxime
[S. PNEUMONIAE]
MIC 0.1-1 mg/L
Standard Therapy
MIC 0.1-1 mg/L
Standard Therapy
18
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Ceftriaxone: 2 g, Q12
Cefotaxime: 2 g, Q4
Cefotaxime: 2 g, Q4
[S. PNEUMONIAE]
MIC 0.1-1 mg/L
Standard Therapy
Dose and Frequency
MIC 0.1-1 mg/L
Standard Therapy
Dose and Frequency
19
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Meropenem, Cefepime (not used because Strep is g(+))
[S. PNEUMONIAE]
MIC 0.1-1 mg/L
Alternative Therapy
MIC 0.1-1 mg/L
Alternative Therapy
20
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Meropenem: 2 g, Q8
Cefepime: 2 g, Q8 (not used because Strep is g(+))
Cefepime: 2 g, Q8 (not used because Strep is g(+))
[S. PNEUMONIAE]
MIC 0.1-1 mg/L
Alternative Therapy
Dose and Frequency
MIC 0.1-1 mg/L
Alternative Therapy
Dose and Frequency
21
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Chloramphenicol: 50-100 mg/kg/d, Q6
[S. PNEUMONIAE]
MIC 0.1-1 mg/L
B-lactam allergy
Dose and Frequency
MIC 0.1-1 mg/L
B-lactam allergy
Dose and Frequency
22
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(Ceftriaxone + Vancomycin) OR (Cefotaxime + Vancomycin)
[S. PNEUMONIAE]
Penicillin MIC >2 mg/L, Ceftriaxone >1 mg/L
Standard Therapy
Penicillin MIC >2 mg/L, Ceftriaxone >1 mg/L
Standard Therapy
23
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Ceftriaxone 2 g, Q12 + Vancomycin
Cefotaxime 2 g, Q4 + Vancomycin
Cefotaxime 2 g, Q4 + Vancomycin
[S. PNEUMONIAE]
Penicillin MIC >2 mg/L, Ceftriaxone >1 mg/L
Standard Therapy
Dose and Frequency
Penicillin MIC >2 mg/L, Ceftriaxone >1 mg/L
Standard Therapy
Dose and Frequency
24
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Moxifloxacin 400 mg, Q24
[S. PNEUMONIAE]
Penicillin MIC >2 mg/L, Ceftriaxone >1 mg/L
Alternative
Dose and Frequency
Penicillin MIC >2 mg/L, Ceftriaxone >1 mg/L
Alternative
Dose and Frequency
25
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7-10 days
[N. MENINGITIDIS]
Duration of Treatment
Duration of Treatment
26
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Penicillin G, Ampicillin
[N. MENINGITIDIS]
Penicillin MIC
Penicillin MIC
27
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Penicillin G: 4 m units, Q4
Ampicillin: 2 g, Q4
Ampicillin: 2 g, Q4
[N. MENINGITIDIS]
Penicillin MIC
Penicillin MIC
28
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Ceftriaxone, Cefotaxime
[N. MENINGITIDIS]
Penicillin MIC
Penicillin MIC
29
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Ceftriaxone: 2 g, Q12
Cefotaxime: 2 g, Q4
Cefotaxime: 2 g, Q4
[N. MENINGITIDIS]
Penicillin MIC
Penicillin MIC
30
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Chloramphenicol: 50-100 mg/kg/d, Q6
[N. MENINGITIDIS]
Penicillin MIC
Penicillin MIC
31
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Ceftriaxone, Cefotaxime
[N. MENINGITIDIS]
Penicillin MIC 0.1-1 mg/L
Standard Therapy
Penicillin MIC 0.1-1 mg/L
Standard Therapy
32
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Ceftriaxone: 2 g, Q12
Cefotaxime: 2 g, Q4
Cefotaxime: 2 g, Q4
[N. MENINGITIDIS]
Penicillin MIC 0.1-1 mg/L
Standard Therapy
Dose and Frequency
Penicillin MIC 0.1-1 mg/L
Standard Therapy
Dose and Frequency
33
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Meropenem, Cefepime
[N. MENINGITIDIS]
Penicillin MIC 0.1-1 mg/L
Alternative
Penicillin MIC 0.1-1 mg/L
Alternative
34
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Meropenem: 2 g, Q8
Cefepime: 2 g, Q8
Cefepime: 2 g, Q8
[N. MENINGITIDIS]
Penicillin MIC 0.1-1 mg/L
Alternative
Dose and Frequency
Penicillin MIC 0.1-1 mg/L
Alternative
Dose and Frequency
35
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Chloramphenicol: 50-100 mg/kg/d, Q6
Moxifloxacin: 400 mg, Q24
Moxifloxacin: 400 mg, Q24
[N. MENINGITIDIS]
Penicillin MIC 0.1-1 mg/L
B-lactam allergy
Dose and Frequency
Penicillin MIC 0.1-1 mg/L
B-lactam allergy
Dose and Frequency
36
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7-10 days
[H. INFLUENZAE]
Duration of Treatment
Duration of Treatment
37
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Ampicillin: 2 g, Q4
[H. INFLUENZAE]
B-lactamase Negative
Standard Therapy
Dose and Frequency
B-lactamase Negative
Standard Therapy
Dose and Frequency
38
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Ceftriaxone, Cefotaxime, Cefepime
[H. INFLUENZAE]
B-lactamase Negative
Alternative
B-lactamase Negative
Alternative
39
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Ceftriaxone: 2 g, Q12
Cefotaxime: 2 g, Q4
Cefepime: 2 g, Q8
Cefotaxime: 2 g, Q4
Cefepime: 2 g, Q8
[H. INFLUENZAE]
B-lactamase Negative
Alternative
Dose and Frequency
B-lactamase Negative
Alternative
Dose and Frequency
40
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Chloramphenicol: 50-100 mg/kg/d, Q6
Moxifloxacin: 400 mg, Q24
Moxifloxacin: 400 mg, Q24
[H. INFLUENZAE]
B-lactamase Negative
B-lactam allergy
Dose and Frequency
B-lactamase Negative
B-lactam allergy
Dose and Frequency
41
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Ceftriaxone, Cefotaxime
[H. INFLUENZAE]
B-lactamase Positive
Standard Therapy
B-lactamase Positive
Standard Therapy
42
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Ceftriaxone: 2 g, Q12
Cefotaxime: 2 g, Q4
Cefotaxime: 2 g, Q4
[H. INFLUENZAE]
B-lactamase Positive
Standard Therapy
Dose and Frequency
B-lactamase Positive
Standard Therapy
Dose and Frequency
43
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Cefepime: 2 g, Q8
[H. INFLUENZAE]
B-lactamase Positive
Alternative
Dose and Frequency
B-lactamase Positive
Alternative
Dose and Frequency
44
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Chloramphenicol: 50-100 mg/kg/d, Q6
Moxifloxacin: 400 mg, Q24
Moxifloxacin: 400 mg, Q24
[H. INFLUENZAE]
B-lactamase Positive
B-lactam allergy
Dose and Frequency
B-lactamase Positive
B-lactam allergy
Dose and Frequency
45
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21 days
[L. MONOCYTOGENES]
Duration of treatment
Duration of treatment
46
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Ampicillin: 2 g, Q4
[L. MONOCYTOGENES]
Standard Therapy
Dose and Frequency
Standard Therapy
Dose and Frequency
47
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Meropenem: 2 g, Q8
[L. MONOCYTOGENES]
Alternative
Dose and Frequency
Alternative
Dose and Frequency
48
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Trimethoprim/Sulfamethoxazole: 10-20 mg TMP/kg/d, Q6-12
[L. MONOCYTOGENES]
B-lactam allergy
Dose and Frequency
B-lactam allergy
Dose and Frequency
49
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2-3 weeks
4-6 weeks w shunt
4-6 weeks w shunt
[MSSA]
Duration of Treatment
Duration of Treatment
50
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Nafcillin or Oxacillin: 1.5-3 g, Q4
[MSSA]
Standard Therapy
Dose and Frequency
Standard Therapy
Dose and Frequency
51
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Meropenem: 2 g, Q8
[MSSA]
Alternative
Dose and Frequency
Alternative
Dose and Frequency
52
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Vancomycin
[MSSA]
B-lactam allergy
B-lactam allergy
53
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3-4 weeks
4-6 weeks w shunt
4-6 weeks w shunt
[MRSA]
Duration of treatment
Duration of treatment
54
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Vancomycin: 15-20 mg/kg, Q12
[MRSA]
Standard therapy
Dose and Frequency
Standard therapy
Dose and Frequency
55
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Trimethoprim/Sulfamethoxazole: 10-20 mg TMP/kg/d, Q6-12
Linezolid: 600 mg, Q12
Linezolid: 600 mg, Q12
[MRSA]
Alternative
Dose and Frequency
Alternative
Dose and Frequency
56
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Amphotericin B + Flucytosine (2-6 weks)
[C. NEOFORMANS]
Standard Therapy
Initiation Therapy
Standard Therapy
Initiation Therapy
57
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Amphotericin B, AMphotericin B + Fluconazole, Amphotericin B + Itraconazole/Voriconazole
[C. NEOFORMANS]
Alternative
Initiation Therapy
Alternative
Initiation Therapy
58
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Itraconazole, Fluconazole
[C. NEOFORMANS]
Standard Therapy
Consolidation Therapy
Standard Therapy
Consolidation Therapy
59
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Herpes simplex virus, West Nile virus, Enteroviruses
[VIRAL]
Pathogens
Pathogens
60
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Acyclovir: 10 mg/kg, Q8H
[VIRAL]
Standard Therapy
Dose and Frequency
Standard Therapy
Dose and Frequency
61
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Foscarnet: 120-200 mg/kg IV per day in divided doses every 8-12 hours
[VIRAL]
Alternative
Dose and Frequency
Alternative
Dose and Frequency
62
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14-21 days
[VIRAL]
Duration of Treatment
Duration of Treatment
63
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H. influenzae: 0.15 mg/kg/d, Q6 for 2-4 days
Pneumococcal: 10 mg, Q6 for 2-4 days
Pneumococcal: 10 mg, Q6 for 2-4 days
[DEXAMETHASONE]
Child
Adult
Child
Adult
64
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Rifampin 600 mg PO BID x 2 days
Ciprofloxacin 500 mg PO x1 dose
Ceftriaxone 250 mg IM x 1 dose
Azithromycin 500 mg PO x 1 dose
Ciprofloxacin 500 mg PO x1 dose
Ceftriaxone 250 mg IM x 1 dose
Azithromycin 500 mg PO x 1 dose
[PROPHYLAXIS]
N. meningitidis
Dose and Frequency
N. meningitidis
Dose and Frequency
65
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Rifampin 600 mg PO BID x 4 days
[PROPHYLAXIS]
H. influenzae
Dose and Frequency
H. influenzae
Dose and Frequency