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Head CT prior to LP:
- A normal neuro exam has high sensitivity and negative predictive value, so can be used to determine if Head CT is needed
Posted 07/05/16 11:00:47 AM by Adam Faye
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Meningitis:
-Ceftriaxone - used for pneumococcal coverage
-Vancomycin - used for Resistant pneumococcal coverage
-Ampicillin - used for Listeria
-Cefepime, better than Zosyn for CNS penetration (if needed for spesis)
**HHV-6 can cause encephalitis in immuno-suppressed hosts**
Posted 07/05/16 01:59:41 PM by Adam Faye
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CSF Studies:
- PMNs point more towards bacteria
- if 0 RBC's - less likely HSV
- Listeria more likely to present with lymphocytosis
Posted 07/05/16 03:39:24 PM by Adam Faye
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Dexamethasone for Meningitis
- Early treatment with steroids can reduce mortality and "unfavorable outcomes - mostly neuro related" (see trial below).
- Should be given 15-20 minutes before or at the time of antibiotic administration
Posted 07/05/16 03:42:55 PM by Adam Faye
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-Staphylococcus (MSSA/MRSA) in urine often comes from bacteremia
Posted 07/05/16 03:47:02 PM by Adam Faye
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Beta-lactam + Aminoglycoside for Endocarditis
- Clears bacteremia faster but does NOT improve mortality. Cure rates were similar, but more evidence of renal toxicity in those which an aminoglycoside was used for synergy
Posted 07/05/16 03:50:41 PM by Adam Faye
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How to think about need for Surgery with Endocarditis: (see below)
- Cardiac complications (Heart Block, Severe Valvulopathy)
- Failure to treat infection on Abx
- Embolic complications
Treatment course - Usually 6 weeks after initiation of ABx or of surgery (source control)
Posted 07/05/16 03:55:36 PM by Adam Faye
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For further reading...
Posted 07/05/16 03:43:28 PM by Adam Faye