中枢神经系统感染220108142426590.pptVIP

* R1’s: What is the most common cause of bacterial meningitis in the developed world? R2’s: What is most common viral cause of meningitis? R3’s: Name a drug that is known to cause meningitis? Drugs: ibuprofen, erythromycin, amoxicillin, OKT3, azathiprine, INH Autoimmune – SLE; Behcets (sm vessel vasculitis) * * * * * * * * * * * * * * * * * * * Shock: Sepsis Protocol Summary: An Approach to the Adult Patient with Suspected Bacterial Meningitis From supplement to: Van de Beek D. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006; 354:44-53 Shock: Sepsis Protocol Summary: An Approach to the Adult Patient with Suspected Bacterial Meningitis Corticosteroids Give dexamethasone IV before or with 1st dose of antibiotics Contraindications Antibiotics w/in 48 hrs Shunt Head trauma From supplement to: Van de Beek D. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006; 354:44-53 Shock: Sepsis Protocol Summary: An Approach to the Adult Patient with Suspected Bacterial Meningitis From supplement to: Van de Beek D. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006; 354:44-53 Contraindications to LP Recent seizure Signs of herniation at any time GCS 11 or rapidly declining LOC Focal neurologic deficits Papilledema * SOL or brain shift on CT Coagulopathy Shock: Sepsis Protocol From supplement to: Van de Beek D. Community-acquired bacterial meningitis in adults. N Engl J Med. 2006; 354:44-53 Summary: An Approach to the Adult Patient with Suspected Bacterial Meningitis Empiric Antibiotic Therapy Cefotaxime 2g IV or Ceftriaxone 2g IV +/- Ampicillin 3g IV +/- Vancomycin 1g IV Antibiotic treatment of meningitis Treatment before hospitalisation* Benzylpenicillin (60 mg/kg, up to) 3 g intravenously or intramuscularly or ceftriaxone (50 mg/kg, up to) 2 g intravenously (in patients hypersensitive to penicillin or in remote areas where further parenteral therapy may be substantially delayed [over 6 h]).