Meningitis, causes

Meropenem (Merrem IV) inhibits syndiesis of die bacterial cell wall and causes die deadi of susceptible cells. This drug is used for intra-abdominal infections caused by Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae, and odier susceptible organisms Meropenem also is effective against bacterial meningitis caused by Neisseria meningitidis, Streptococcus pneumoniae, and Hemophilus influenzae. 

There is concern regarding administration of dexamethasone to patients with pneumococcal meningitis caused by penicillin- or cephalosporin-resistant strains, for which vancomycin would be required. Animal models indicate that concurrent steroid use reduces vancomycin penetration into the CSF by 42% to 77% and delays CSF sterilization due to reduction in the inflammatory response.23 Treatment failures have been reported in adults with resistant pneumococcal meningitis who were treated with dexamethasone, but the risk-benefit of using dexamethasone in these patients cannot be defined at this time. Animal models indicate a benefit of adding rifampin in patients with resistant pneumococcal meningitis whenever dexamethasone is used.21,23... 

Biering, G. Karlsson, S. Clark, N. C. Jonsdottir, K. E. Ludvigsson, P. Steingrimsson, O. Three cases of neonatal meningitis caused by Enterobacter sakazakii in powdered milk. J. Clin. Microbiol. 1989, 27, 2054-2056. 

Jaspar, A. H. Muytjens, H. L. Kollee, L. A. [Neonatal meningitis caused by Enterobacter sakazakii Milk powder is not sterile and bacteria like milk too ] Tijdschr. Kindergeneeskd 1990,58,151-155. 

Meningitis causes CSF fluid changes, and these changes can be used as diagnostic markers of infection (Table 36-1). 

Meningitis caused by S. pneumoniae is successfully treated with 10 to 14 days of antibiotic therapy. Meningitis caused by N. meningitidis usually can be treated with a 7-day course. A longer course, >21 days, is recommended... 

Antimicrobial Agents of First Choice and Alternative Choice for Treatment of Meningitis Caused by Gram-Positive and Gram-Negative Microorganisms]... 

Optimal antibiotic therapies for gram-negative bacillary meningitis have not been fully defined. Meningitis caused by Pseudomonas aeruginosa is initially treated with ceftazidime or cefepime, piperacillin + tazobactam, or meropenem plus an aminoglycoside, usually tobramycin. 

Meningitis caused by susceptible strains of pneumococcus and meningococcus... 

Bacterial meningitis (pediatric patients 3 months of age or older only) Bacterial meningitis caused by Streptococcus pneumoniae, Haemophilus influenzae ( -lactamase and non- -lactamase-producing strains), and Neisseria meningitidis. 

The pharmacokinetic properties of aztreonam are similar to those of the parenteral cephalosporins (Table 45.2). Aztreonam is not bioavailable after oral administration. During its distribution phase, the drug can achieve therapeutic concentrations in cerebrospinal fluid in the presence of inflamed meninges. Consequently, aztreonam is an alternative antibiotic to the cephalosporins for the therapy of meningitis caused by gram-negative bacilli. 

It is valuable in critically ill patients with impaired host defence Pseudomonas or Proteus infections in burns, urinary tract infections, lung abscesses, osteomyelitis, middle ear infection, septicaemia meningitis caused by gram negative bacilli, peritonitis, in skin and soft tissue infections and postoperative infection. 

Because of potential toxicity, bacterial resistance, and the availability of many other effective alternatives, chloramphenicol is rarely used. It may be considered for treatment of serious rickettsial infections such as typhus and Rocky Mountain spotted fever. It is an alternative to a B-lactam antibiotic for treatment of meningococcal meningitis occurring in patients who have major hypersensitivity reactions to penicillin or bacterial meningitis caused by penicillin-resistant strains of pneumococci. The dosage is 50-100 mg/kg/d in four divided doses. 

Clinical Use. Amphotericin B (Amphocin, Fungizone Intravenous) is one of the primary drugs used to treat severe systemic fungal infections.26,39 This drug is often chosen to treat systemic infections and meningitis caused by Candida, Cryptococcus, and several other... 

Rifampin is used in a variety of other clinical situations. An oral dosage of 600 mg twice daily for 2 days can eliminate meningococcal carriage. Rifampin, 20 mg/kg/d for 4 days, is used as prophylaxis in contacts of children with Haemophilus influenzae type b disease. Rifampin combined with a second agent is used to eradicate staphylococcal carriage. Rifampin combination therapy is also indicated for treatment of serious staphylococcal infections such as osteomyelitis and prosthetic valve endocarditis. Rifampin has been recommended also for use in combination with ceftriaxone or vancomycin in treatment of meningitis caused by highly penicillin-resistant strains of pneumococci. 

Distribution All of these antibiotics distribute very well into body fluids. However, adequate therapeutic levels in the cerebrospinal fluid (CSF), regardless of inflammation, are achieved only with the third generation cephalosporins (for example, ceftriaxone or cefotaxime are effective in the treatment of neonatal and childhood meningitis caused by Haemophilus influenzae). Cefazolin (se FA zo lin) finds application in orthopedic surgery because of its activity against penicillinase-producing Staphylococcus aureus, its half-life and its ability to penetrate bone. 

C. Ampicillin Bacterial meningitis caused by Haemophilus influenzae (p-lactamase negative)... 

A. It is frequently used prophylactically for household members exposed to meningitis caused by meningococci or Haemophilus influenzae. 

Flucytosine [floo SYE toe seen] (5-FC) is a synthetic pyrimidine anti metabolite used only in combination with amphotericin for the treatment of systemic mycoses and meningitis caused by Cryptococcus neoformans and Candida. 

Haemophilus influenzae type B, a Gram-negative cocco-bacillus, accounts for approximately 40 cases per year. The incidence of meningitis caused by Haemophilus influenzae type B has fallen considerably following introduction of the Hib vaccine in 1992. 

Using a post hoc analysis of the patients treated in the S. aureus bacteraemia clinical trial, Lalani et al.72 reviewed the outcomes of patients with osteo-articular infections (OAI) and found that daptomycin may be effective at treating OAI associated with staphylococcal bacteraemia. Daptomycin has also been used successfully to treat meningitis caused by MRSA.73... 

Polymerase chain reaction (PCR) techniques can be used to diagnose meningitis caused by M meningitidis, S. pneumoniae, and H. influenzaetype b (Hib). PCR is considered to be highly sensitive and specific. PCR testing of the CSF is the preferred method of diagnosing most viral meningitis infections. 

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