meningitis
DESCRIPTION
Meningitis. By: Sahar Bannani ID Intern. Practical Guidelines for the Management of Bacterial Meningitis. Developed By: Infectious Diseases Society of America Date Released: November 2004 Date Modified: March 2008. Guideline Category:. Diagnosis Evaluation Management Treatment. - PowerPoint PPT PresentationTRANSCRIPT
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MeningitisBy:
Sahar BannaniID Intern
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Practical Guidelines for the Management of Bacterial
Meningitis• Developed By:
Infectious Diseases Society of America
• Date Released:November 2004
• Date Modified:March 2008
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Guideline Category:
• Diagnosis• Evaluation• Management• Treatment
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Rating Scheme
• Strength of Evidence:I, II, III
• Strength of the Recommendations:A, B, C, D, E
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Diagnosis
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Diagnosis
• LP:–WBCs, RBCs,
Bacteria, Proteins, Glucose
– Lactate– CRP– Gram Stain– Latex
Agglutination Test– Limulus Lysate
Assay– PCR / RT-PCR
• Hx and P/Ex• Blood Cultures• LP• Serum
Procalcitonin• CT
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Which Patients with Suspected Bacterial Meningitis Should
Undergo CT before LP?
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B-II
• Immunocompromised State• Hx of CNS Disease• New Onset Seizure• Papilledema• Abnormal Level of Consciousness• Focal Neurological Deficit
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What Specific CSF Diagnostic Tests Should Be Used to Determine
the Bacterial Etiology of Meningitis?
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• Gram Stain (A-III)
• Latex Agglutination (D-II)– G-Stain –ve (C-II)– Pretreated (B-III)
• Limulus Lysate Assay (D-II)
• PCR (B-II)
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What Lab Tests Helps in Distinguishing Bacterial from Viral Meningitis?
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Bacterial vs. Viral
• Lactate Concerntration (D-III)– Post-op NeuroSurg (B-II)
• CRP (B-II)
• Procalcitonin (C-II)
• PCR (B-II)
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Treatment
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How Quickly Should Antimicrobial Therapy
be Administered in Suspected Bacterial
Meningitis?
C-III
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Empirical Antimicrobial
Therapy (A-111)Ampi + CefotaximeOR Ampi + Aminoglycoside
< 1 month
Vanco + 3G Cephalo± Rifampin (with Dexa)
1-23 months
Vanco + 3G Cephalo± Rifampin (with Dexa)
2-50 years
Vanco + 3G Cephalo + Ampi± Rifampin (with Dexa)
> 50 years
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Specific Antimicrobial Therapy (A-111)
• Child + suspected L. Monocytogenes: Ampi + 3G Ceph + Vanco• Child + Suspected G-ve enteric bacteria: Ampi +
Aminoglycoside
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Duration of Antimicrobial
Therapy(A-III)
• N. meningitidis, H. influenza 7 days
• S. pneumoniae 10 – 14 days
• S. agalactiae 14 – 21 days
• Aerobic G-ve Bacilli, L. monocytogenes 21 days
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Role of Dexa
• Neonates (C-I)• Infants and Children:– H. influenza b (A-I)– Post Antimicrobial Rx (A-I)– Pneumococcal (C-I)
• Adults:– Pneumococcal (A-I)– Post Antimicrobial Rx (A-I)– All (B-III)
• Pneumococcal Meningitis (B-III)– Rifampin + Vanco + 3G Ceph + Dexa (B-
III)
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Specific Antimicrobial
Therapy
• Cephalosporins• Vancomycin• Rifampin• Carbapenems• Flouroquinolones
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Bacterial Meningitis postCSF-Shunting
• Do we administer Antimicrobial Therapy by Intraventricular Route?
(A-III) vs. (B-III)
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Bacterial Meningitis fromPre-Existing CSF-Shunt
• Do we remove the shunt? And when a new one can be implanted?
(A-II)(B-II)(C-III)
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Indications for Repeated LP
(A-III)
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Criteria for Out-Patient Rx(A-III)
• In-patient Rx ≥ 6 days• Afebrile 24-48 hrs• No neuro dysfunction• Stable• PO intake• Access to home nursing for Rx• Reliable IVL and infusion device (if needed)• Daily availability of a physician• Plan• Compliance• Safe environment
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Management Algorithm for Children with Suspected Bacterial Meningitis
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Management Algorithm for Adults with Suspected Bacterial Meningitis
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Questions ?!
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Comments ?!
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THANKYOU