Bacterial Meningitis

This morning we talked about a case of bacterial meningitis.  This is a disease that is rare but has significant mortality and morbidity, so it is important to be familiar with how to diagnose and treat it. Here are a few key point we discussed this morning.

1. Do not delay antibiotics for procedures such as CT head or LP
2. Antibiotic doses of meningitis are different (and much higher) 
3. Even if the CSFcultures are sterilized by prior antibiotics, other clues such as degree of neutrophillia, CSF glucose level, or the gram stain can point toward bacterial meningitis
4. No everyone needs a CT head
5. IDSA recommendation for CT prior to lumbar puncture is below:
1. Immunocompromised state
2. History of CNS disease Mass lesion, stroke, or focal infection
3. New onset seizure Within 1 week of presentation;
4. Papilledema
5. Abnormal level of consciousness …
6. Focal neurologic deficit
7. fields, gaze palsy, arm or leg drift

 Here is a review from Lance on management of bacterial meningitis. 

**Gram stain CSF: GPC in pairs and short chains suggestive of Streptococcus pneumoniae

The Right dose at the Right time

This morning we discussed a case of fever and headache. We reviewd the approach to diagnosis and treatment of bacterial meningitis. Two key points from our discussion were:

1. Antibiotic therapy should not be delayed for any reason and should be given immediately after blood cultures are obtained. Dexamethasone should be given shortly before or at the same time as the first dose of antibiotics, when S. pneumoniae is suspected.

2. The "meningitis doses" of the empiric antibiotics in patients with normal renal function is: Vancomycin 1.5-2g IV q12, Ceftriaxone 2 g IV every 12 hours, and if Listeria suspected Ampicillin 2gr IV q4hr.


Here is a previous post on Meningitis.

*Steptococcus Pneumoniae, a gram postive cocci in chains, is the most common cause of community acquired bacterial meningitis in adults.