Monday, November 28, 2022

What Antibiotic Is Used To Treat Meningitis

Treatment Of Subacute Meningitis

4. Bacterial Meningitis Treatment & Prevention

Patients with subacute meningitis are more commonly immunosuppressed, have comorbidities, have fungal etiologies, have higher rates of hypoglycorrhachia, and have abnormal neurological findings than patients with acute meningitis. Furthermore, patients with subacute meningitis are less likely to be treated empirically with intravenous antibiotics and have lower levels of CSF pleocytosis and serum WBC counts than patients with acute meningitis.

Acrylamide Polymers With Gb3 Trisaccharides

Watanabe et al. constructed acrylamide polymers of Gb3 as toxin absorbent in the gut that bound both Stx1 and Stx2 with a very high affinity . They further showed that the oral administration of these polymers was able to protect mice that had been orally challenged with a fatal dose of STEC, whereby the toxin content in serum samples in the treated infected mice was significantly reduced. This protection was observed even if the polymers were administered after colonization.

Emerging Trends In Resistance Among E Coli

E. coli, especially the ExPEC pathotype, is an important cause of community and nosocomial-acquired infections, especially of urinary tract infections, bloodstream infections, surgical site infections, pneumonia and sepsis .The cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole are considered as 1st line agents and often used to treat community and hospital infections caused by E. coli. The management of infections caused by ExPEC has been complicated by the emergence of antimicrobial resistance to first line antibiotics . Until the late 1990s, ExPEC were relatively susceptible to 1st line antibiotics, however severalsurveillance studies during the 2000s across Europe, North and South America, have shown that between 20 55% of ExPEC are resistant to 1st line antibiotics including the cephalosporins, fluoroquinolones, and trimethoprim-sulfamethoxazole . Resistance to these agents is causing delays in appropriate therapy with subsequent increased morbidity and mortality .

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Prevention Of Bacterial Meningitis

Some forms of meningitis can be prevented by immunisation:

  • Haemophilus influenzae type b can be prevented with Hib immunisation, which is available for free through the National Immunisation Program Schedule. It is routinely offered for babies but needs to be purchased on prescription for some groups at high risk of bacterial disease.
  • The National Immunisation Program schedule provides a free meningococcal ACWY vaccine for:
  • children at 12 months of age
  • people under 20 years of age who did not have their meningococcal C vaccine at 12 months of age
  • secondary school students in Year 10, or age equivalent, through a school-based immunisation program. Young people aged 15 to 19 years who have not already received the vaccine in school will be able to be vaccinated by their immunisation provider.
  • Meningococcal B vaccine is not funded on the National Immunisation Program but can be purchased by prescription.
  • Pneumococcal can be prevented with two types of pneumococcal vaccine. They are available free on the National Immunisation Schedule to:
  • Aboriginal and Torres Strait Islander people who are 50 years of age or over
  • non-Aboriginal and Torres Strait Islander people who are 65 years of age and over.
  • Pneumococcal vaccines need to be purchased on prescription for some groups at high risk of bacterial disease.

    Meningococcal vaccines are recommended for:

    Can Antibiotics Help Viral Meningitis

    CNS infections

    Antibiotics do not help viral infections, so they are not useful in the treatment of viral meningitis. However, antibiotics do fight bacteria, so they are very important when treating bacterial meningitis. People who develop severe illness, or are at risk for developing severe illness, may need care in a hospital.

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    What Causes Bacterial Meningitis

    The bacteria most often responsible for bacterial meningitis are common in the environment and can also be found in your nose and respiratory system without causing any harm.

    Sometimes meningitis occurs for no known reason. Other times it occurs after a head injury or after you have had an infection and your immune system is weakened.

    How Long Does It Take For E Coli To Affect You

    When an infectious strain of E. coli is ingested, it typically takes three days for symptoms to appear. Symptoms of E. coli intestinal infection include watery diarrhea , abdominal cramps, nausea, vomiting, and sometimes fever. Bloody diarrhea is often an indicator that dangerous strains of E. coli, called enterohemorrhagic E. coli, have invaded the intestinal walls.

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    Antibiotic Therapy: Age 1

    In infants 1 to 3 months of age, the first-line agent is cefotaxime or ceftriaxone plus ampicillin . An alternative agent is chloramphenicol plus gentamicin .

    If the local prevalence of drug-resistant S pneumoniae is higher than 2%, vancomycin should be added. Treatment with dexamethasone should be strongly considered, starting 15 to 20 minutes before the first dose of antibiotics.

    History And Physical Examination

    Bacterial Meningitis (CNS Infection) â Infectious Diseases | Lecturio

    Collect a careful history from patient, addressing information such as previous illnesses, surgeries, how long ago the symptoms started, if there are comorbidities, if it have traveled to a place recently and other details, added to a complete physical examination, which provides very relevant information and leads to a line of rationality, it is extremely important to start the development of a preliminary differential diagnosis of the patients complaints.

    All this information collected is recorded and saved in medical records, more recently, electronics, which are more organized, more readable and allows a better comparison, in relation to written records .

    Some of the most frequent reasons that lead patients to go to a medical consultation are dyspnea, cough with or without hemoptysis and chest pain, as these symptoms can be indications of serious illnesses, it shows the importance of asking questions and exams in a way attentive and careful .

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    Prevention Of Viral Meningitis

    You can prevent the spread of viral meningitis by:

    • washing your hands thoroughly after using the toilet, changing a nappy or blowing your nose, and before touching food
    • covering your coughs and sneezes with a tissue, or coughing or sneezing into your sleeve
    • avoiding close contact with other people, such as kissing
    • stay home from work, childcare, kinder or school if you are unwell.

    Enhancing Healthcare Team Outcomes

    The diagnosis of neonatal meningitis can be a devastating one. However, today mortality is lower, due to aggressive treatment with antibiotics, antiviral, and advanced neonatal medicine. An interprofessional team approach including physicians, nurses, pharmacists, and caseworkers can help not only treat the patient but the parents as well. Neurologic sequelae that can result will require, in many cases, lifelong care. Over his or her lifetime, they will need physical therapy, cognitive therapy, medication, and social support. This will center on the childs primary pediatrician, who can coordinate therapies and specialist consultations, including neurology, and if the sequelae are severe enough, home health care.

    There are clinical decision rules to help determine which children should be admitted and who can be safely discharged. The Bacterial Meningitis Score, which can identify very low risk patients, has been tested and reaffirmed in several studies and shows it can help decrease costs and increase patient safety by decreasing unnecessary, and possibly harmful, treatments and testing. However, it cannot be used in the less than 60-day-old age group, as there has been uncertainty regarding its validity in this population.

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    Are There Any Drug Interactions With Warfarin Sodium

    Warfarin sodium and Nitrofurantoin drug interactions ? from FDA reports. Drug interactions are reported among people who take Warfarin sodium and Nitrofurantoin together. This study is created by eHealthMe based on reports of 98 people who take Warfarin sodium and Nitrofurantoin from FDA, and is updated regularly.

    Antibiotic Therapy: Age 50 Years

    Cefuroxime molecule. It is second

    In adults older than 50 years or adults with disabling disease or alcoholism, the most common microorganisms are S pneumoniae, coliforms, H influenzae, Listeria species, P aeruginosa, and N meningitidis.

    Primary treatment, if the prevalence of DRSP is greater than 2%, is with either cefotaxime or ceftriaxone plus vancomycin . If the CSF gram stain shows gram-negative bacilli, ceftazidime is given. In areas of low DRSP prevalence, treatment consists of cefotaxime or ceftriaxone plus ampicillin . Other options are meropenem, TMP-SMX, and doxycycline.

    The Infectious Diseases Society of America guidelines recommend adjunctive dexamethasone in patients with suspected or proven community-acquired bacterial meningitis, but only in high-income countries. The first dose of dexamethasone is given 15 to 20 minutes before the first dose of antibiotics.

    Dexamethasone should be continued if the culture grows either S pneumoniae or H influenzae. However, some experts advise that adjunctive treatment should be continued irrespective of the causative bacterium because of the low incidence of adverse events.

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    Treatment Of Bacterial Meningitis

    Bacterial meningitis is a neurologic emergency that is associated with significant morbidity and mortality. Initiation of empiric antibacterial therapy is therefore essential for better outcome.

    Table 7. Recommended Empiric Antibiotics for Suspected Bacterial Meningitis, According to Age or Predisposing Factors

    Age or Predisposing Feature

    Ampicillin plus either cefotaxime or an aminoglycoside

    Age 1 mo-50 y

    Vancomycin plus cefotaxime or ceftriaxone*

    Age > 50 y

    Vancomycin plus ampicillin plus ceftriaxone or cefotaxime plus vancomycin*

    Impaired cellular immunity

    Vancomycin plus ampicillin plus either cefepime or meropenem

    Recurrent meningitis

    Vancomycin plus cefotaxime or ceftriaxone

    Basilar skull fracture

    Vancomycin plus cefotaxime or ceftriaxone

    Head trauma, neurosurgery, or CSF shunt

    Vancomycin plus ceftazidime, cefepime, or meropenem

    CSF = cerebrospinal fluid.

    *Add ampicillin if Listeria monocytogenes is a suspected pathogen.

    Table 8. Specific Antibiotics and Duration of Therapy for Acute Bacterial Meningitis

    It is vital to institute empiric antimicrobial therapy as soon as possible. The choice of agents is usually based on the known predisposing factors, initial CSF Gram stain results, or both. Once the pathogen has been identified and antimicrobial susceptibilities determined, the antibiotics may be modified for optimal targeted treatment.

    • < 2 µg/mL Susceptible

    For meningitis, the breakpoints are as follows:

    • < 0.06 µg/mL Susceptible

    • 0.12 µg/mL Resistant

    How Is Bacterial Meningitis Treated

    Bacterial meningitis is treated with antibiotics. A general intravenous antibiotic with a corticosteroid to bring down the inflammation may be prescribed even before all the test results are in. When the specific bacteria are identified, your doctor may decide to change antibiotics. In addition to antibiotics, it will be important to replenish fluids lost from loss of appetite, sweating, vomiting and diarrhea.

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    What Antibiotics Treat E Coli Uti

    Following a positive urinalysis, your doctor may prescribe Bactrim or Cipro, two medicines often used to treat E. coli UTIs. If these drugs dont work, your doctor may suggest another antibiotic. There are many different classes of medications available, so your doctor will likely be able to find something that will clear up your infection without causing too many side effects.

    An E. coli bacteria infection can be treated with any of several different antibiotics depending on which strain is responsible for the infection. The most common antibiotics used to treat E. coli infections are ciprofloxacin and nitrofurantoin .

    What Drugs Interact With Tobramycin

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    Inform your doctor of all medications you are currently taking, who can advise you on any possible drug interactions. Never begin taking, suddenly discontinue, or change the dosage of any medication without your doctors recommendation.

    • Tobramycin has no known severe interactions with other drugs.
    • Tobramycin has serious interactions with at least 25 different drugs.
    • Tobramycin has moderate interactions with at least 66 different drugs.
    • Tobramycin has mild interactions with at least 72 different drugs.

    The drug interactions listed above are not all of the possible interactions or adverse effects. For more information on drug interactions, visit the RxList Drug Interaction Checker.

    It is important to always tell your doctor, pharmacist, or health care provider of all prescription and over-the-counter medications you use, as well as the dosage for each, and keep a list of the information. Check with your doctor or health care provider if you have any questions about the medication.

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    Pearls And Other Issues

    The biggest pitfall of meningitis in infants is not considering it in the first place. Well-appearing febrile infants can become toxic quickly, and are at high risk for SBI due to their immature immune systems.

    The lumbar puncture with a culture of the CSF continues to be the gold standard of diagnosis. PCR may be a test that can be used in the future. Broad-spectrum antibiotics are the standard of care and should include ampicillin plus gentamicin or cefotaxime. Cefotaxime is currently preferred. If suspected, consider adding acyclovir to the regimen. In children with neurologic symptoms consider other etiologies however, meningitis must be ruled out, due to its high morbidity and mortality.

    Antibiotic Therapy: Age 7

    In an older child or an otherwise healthy adult , the most common microorganisms in bacterial meningitis are S pneumoniae, N meningitidis, and L monocytogenes. In areas where the prevalence of DRSP is greater than 2%, primary treatment consists of with either cefotaxime or ceftriaxone plus vancomycin. Pediatric dosing is as follows:

    • Cefotaxime 50 mg/kg IV every 6 hours, up to 12 g/day

    • Ceftriaxone 75 mg/kg initially, then 50 mg/kg every 12 hours, up to 4 g/day

    • Vancomycin 15 mg/kg IV every 8 hours

    Adult dosing is as follows:

    • Cefotaxime 2 g IV every 4 hours

    • Ceftriaxone 2 g IV every 12 hours

    • Vancomycin 750-1000 mg IV every 12 hours or 10-15 mg/kg IV every 12 hours

    Some experts add rifampin . If Listeria is suspected, ampicillin is added.

    An alternative is chloramphenicol or clindamycin or meropenem . Imipenem is a proconvulsant and must be avoided.

    In areas with a low prevalence of DRSP, cefotaxime or ceftriaxone plus ampicillin is recommended. Pediatric dosing is as follows:

    • Cefotaxime 50 mg/kg IV every 6 hours, up to 12 g/day

    • Ceftriaxone 75 mg/kg initially, then 50 mg/kg every 12 hours, up to 4 g/day

    • Ampicillin 50 mg/kg IV every 6 hours

    Adult dosing is as follows:

    • Cefotaxime 2 g IV every 4 hours

    • Ceftriaxone 2 g IV every 12 hours

    • Ampicillin 50 mg/kg IV every 6 hours

    An alternative is chloramphenicol plus trimethoprim-sulfamethoxazole or meropenem .

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    Antibiotics Used For Bacterial Meningitis In Children

    This page was last updated on May 9th, 2017

    Antibiotics are critical in the treatment of meningitis since the bodys immune response in the CNS for fighting the infection is limited. The blood-brain barrier limits delivery of antibodies and complement factors into the CSF. Phagocytosis of encapsulated bacteria in the CSF is thus decreased. Antibiotics must be able to reach high levels in the CSF, and these levels must be maintained at 10 to 20 times the minimal in vitro bactericidal concentrations in order to eradicate the infection. This is the basis for the recommended drugs and dosages presented below.

    Who Gets Bacterial Meningitis

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    Children between the ages of 1 month and 2 years are the most susceptible to bacterial meningitis.

    Adults with certain risk factors are also susceptible. You are at higher risk if you abuse alcohol, have chronic nose and ear infections, sustain a head injury or get pneumococcal pneumonia.

    You are also at higher risk if you have a weakened immune system, have had your spleen removed, are on corticosteroids because of kidney failure or have a sickle cell disease.

    Additionally, if you have had brain or spinal surgery or have had a widespread blood infection you are also a higher risk for bacterial meningitis.

    Outbreaks of bacterial meningitis also occur in living situations where you are in close contact with others, such as college dormitories or military barracks.

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    Meningococcal Group B Vaccine

    The vaccine is administered as a 3-dose series at months 0, 2, and 6 or a 2-dose series given at least 1 month apart . It induces production of bactericidal antibodies directed against the capsular polysaccharides of serogroup B. It is indicated for active immunization to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroup B in individuals aged 10 through 25 years.

    Drugs For Specific Antibiotic Therapy For Bacterial Meningitis

    Organism
    Ampicillin or cefotaxime or ceftriaxone or chloramphenicol
    Penicillin-resistant
    Ampicillin or cefotaxime or ceftriaxone
    Penicillin-resistant
    Penicillin G or ampicillin plus aminoglycoside
    L. monocytogenes
    E. coli, Klebsiella sp., Enterobacter sp. Cefotaxime or ceftriaxone with or without aminoglycoside Ampicillin or broad-spectrum carbapenem
    Salmonella sp. Ampicillin or cotrimoxazole or chloramphenicol
    S. aureus, coagulase-negative Staphyloccus sp.
    Nafcillin or oxacillin or methacillin Vancomycin in patients with penicillin allergy
    Methicillin-resistant Vancomycin plus rifampin

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    Antibiotic Therapy: Age 3 Months To 7 Years

    In older infants or young children , the most common microorganisms are S pneumoniae, N meningitidis, and H influenzae. Primary treatment is with either cefotaxime or ceftriaxone .

    If the prevalence of DRSP is greater than 2%, vancomycin should be added. In countries with a low prevalence of DRSP, penicillin G may be considered. Because of the increasing prevalence of DRSP, penicillin G is no longer recommended in the United States.

    An alternative is chloramphenicol plus vancomycin . Treatment with dexamethasone should be strongly considered, starting 15 to 20 minutes before the first dose of antibiotics.

    Antibiotics For Exposure To Bacterial Meningitis

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    Bacterial meningitis spreads through bodily fluids, including saliva. It can be transmitted if someone close to you coughs.

    You may need to take a preventative course of antibiotics if exposed. Talk with your doctor if you believe you have a suspected or confirmed exposure. Theyll order tests and work with you to develop a plan.

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