中枢神经系统感染220198142426590 课件.ppt

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. 2019; 354:44-53 Shock: Sepsis Protocol Summary: An Approach to the Adult Patient with Suspected Bacterial Meningitis Corticosteroids Give dexamethasone IV before or with 1 st 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. 2019; 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. 2019; 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. 2019; 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]). Empirical treatment in hospital Cefotaxime (child, 50 mg/kg up to) 2 g intravenously, 6-hourly or ceftriaxone (child, 100 mg/kg up to) 4 g intravenously, daily in 1 or 2 divided doses for 7 to 10 days plus benzylpenicillin (child, 60 mg/kg up to) 1.8