•  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

• 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

• 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

• 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

• -Staphylococcus (MSSA/MRSA) in urine often comes from bacteremia
  
  

  Posted 07/05/16 03:47:02 PM by Adam Faye

• 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

• How to think about need for Surgery with Endocarditis: (see below)
  1. Cardiac complications (Heart Block, Severe Valvulopathy)
  2. Failure to treat infection on Abx
  3. 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

• For further reading...

  Dexamethasone in Adults with Bacterial Meningitis
  Indications for Valve Surgery in Endocarditis
  IDSA Guidelines for Endocarditis
  
  
  
  

  Posted 07/05/16 03:43:28 PM by Adam Faye

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