Meningitis selection

The adjunctive agent dexamethasone has been shown to improve outcomes in selected patient populations with meningitis. 

Pediatric Doses of Selected Agents Used in Bacterial Meningitis Treatment... 

The adjunctive agent dexamethasone has been shown to improve outcomes in selected patient populations with meningitis. Dexamethasone inhibits the release of proinflammatory cytokines and limits the CNS inflammatory response stimulated by infection and antibiotic therapy. 

Neurology Lumbago, sciatica, cervicobrachial neuralgia and other painful radiculopathies selected cases of inflammatory disorders such as tuberculous meningitis and multiple sclerosis. 

Sumatriptan and the other triptans are selective agonists for 5-HT1D and 5-HT1B receptors the similarity of the triptan structure to that of the 5-HT nucleus can be seen in the structure below. These receptor types are found in cerebral and meningeal vessels and mediate vasoconstriction. They are also found on neurons and probably function as presynaptic inhibitory receptors. 

Bacteriostatic and bactericidal agents are equivalent for the treatment of most infectious diseases in immunocompetent hosts. Bactericidal agents should be selected over bacteriostatic ones in circumstances in which local or systemic host defenses are impaired. Bactericidal agents are required for treatment of endocarditis and other endovascular infections, meningitis, and infections in neutropenic cancer patients. 

Lumbar puncture is considered mandatory in patients with suspected bacterial meningitis but the procedure can be hazardous with a risk of brain herniation in patients with raised intracranial pressure, and imaging with computed tomography or MRI is recommended for selected patients to detect brain shift. Patients who are in an immunocompromised state, have new-onset seizures, moderate-to-severe impairment of consciousness or signs that are suspicious of space-occupying lesions (e.g. papilloedema - oedema of the optic disk) should undergo neuroimaging prior to lumbar puncture. 

Kawaguchi, T., Kawaguchi, M., Miner, K. M., Lembo, T. M. and Nicolson, G. L. (1983). Brain meninges tumor formation by in vivo-selected metastatic B16 melanoma variants in mice. Clin. Exp. Metastasis 1, 247-259. 

Data on adverse events reported to a passive provincial surveillance system have been evaluated after the mass immunization with a polysaccharide meningococcal vaccine of 1 198 751 people aged 6 months to 20 years in Quebec. A total of 118 reports of severe adverse events were selected. The most frequent were allergic reactions (9.2 per 100 000 doses), followed by few neurological reactions (0.5 per 100 000 doses) and very few anaphylactic reactions (0.1 per 100 000 doses). There were no reports of long-lasting sequelae or of encephalopathy, encephalitis, or meningitis (15). 

After intravenous colistimethate (5 mg/kg/day) the CSF concentration was 25% of the serum concentration in a patient with meningitis (6). For life-threatening meningitis due to such organisms, polymyxins can also be given intrathecaUy as adjunctive therapy (7). Polymyxins are also used in regimens of selective decontamination of the digestive tract (8). 

Aseptic meningitis is a rare adverse effect of non-selective NSAIDs in patients with or without connective tissue disease or rheumatological disease. Rofecoxib has been implicated in five patients (four women and one man), in each case occurring within 12 days of the start of rofecoxib therapy (1). The clinical presentations and cerebrospinal fluid findings were typical of aseptic meningitis. One patient had rheumatoid arthritis. After drug withdrawal and recovery, two consecutive rechallenges in one patient led to relapses. 

Polfliet MMJ, Goede PH, Van Kesteren-Hendrikx EML, Van Rooijen N, Dijkstra CD, Van den Berg TK (2001) A method for the selective depletion of perivascular and meningeal macrophages in the central nervous system. J Neuroimmunol 116 188... 

Initial selection of antimicrobial therapy is nearly always empirical, which is the initiation of antimicrobials sometimes prior to documentation of the presence of infection and before the offending organism is identified. Infectious diseases generally are acute, and a delay in antimicrobial therapy may result in serious morbidity or even mortality. An example is the rapidly lethal nature of various forms of meningitis. Thus empirical antimicrobial therapy selection is... 

The proper route of administration for an antimicrobial depends on the site of infection. Parenteral therapy is warranted when patients are being treated for febrile neutropenia or deep-seated infections such as meningitis, endocarditis, and osteomyelitis. Severe pneumonia often is treated initially with intravenous antibiotics and switched to oral therapy as clinical improvement is evident. Patients treated in the ambulatory setting for upper respiratory tract infections (e.g., pharyngitis, bronchitis, sinusitis, and otitis media), lower respiratory tract infections, skin and soft tissue infections, uncomplicated urinary tract infections, and selected sexually transmitted diseases may receive oral therapy. 

When selecting antibiotics, the clinician must consider the antibiotic concentration at the site of infection, as well as the spectrum of antibacterial activity. Empirical choices should be based on age and predisposing conditions, (a) Ceftriaxone or cefotaxime and vancomycin are reasonable initial choices for empirical coverage of community-acquired meningitis in adult patients, (b) Listeria monocytogenes... 

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