Meningococcal infections meningitis

Streptococcal infections Pharyngitis, rheumatic fever, otitis media and even for subacute bacterial endocarditis. Staphylococcal infections Penicillinase resistant penicillin can be used. Meningococcal infections Meningitis other infections caused by meningococci. 

Despite this setback, the pharmaceutical industry was encouraged to prepare literally hundreds of sulfonamides, of which May and Baker 693 (sul-fapyridine) proved to be the most potent and broad spectrum. It also achieved star status once it was revealed that it had been used to save the life of Winston Churchill when he contracted pneumonia during a visit to North Africa in December 1943. Other sulfonamides that have been widely prescribed are sulfadiazine, sulfadimidine (especially for urinary tract infections and meningitis caused by meningococcal infections) and sulfamethoxazole. One problem with many sulfonamides is their relative water insolubility and their tendency to crystallise in the kidney tubules. They are also metabolised via acetylation of the aniline nitrogen, and these metabolites are both inactive and less soluble. 

QHgNiOiS. Colourless crystals, m.p. 164 5-166-5" C. It is usually prepared by treating p-acetamidobenzenesulphonyl chloride with ammonia, and hydrolysing the acetyl derivative to the base. Used for the treatment of streptococcal infections, gonorrhoea, meningococcal meningitis and urinary infections. Liable to cause unpleasant reactions, such as nausea, cyanosis and skin rashes. 

From a clinical point of view, the sulphonamides are extremely useful for the treatment of uncomplicated urinary tract infection caused by E. coli in domiciliary practice. They have also been employed in treating meningococcal meningitis (a current... 

Penicillin is the dmg of choice for the treatment of group B streptococcal, meningococcal and pneumococcal infections but, as discussed earlier, CSF concentrations of penicillin are significantly influenced by the intensity of the inflammatoiy response. To achieve therapeutic concentrations within the CSF, high dosages are required, and in the case of pneumococcal meningitis should be continued for 10-14 days. 

Determine whether prophylaxis is indicated for close contacts of patients with CNS infections. Close contacts should be located for patients with suspected meningococcal or Hib meningitis. After consultation with the local health department, antibiotic prophylaxis should be provided promptly to these individuals to avoid secondary disease. 

Salmonella and Haemophilus infections and meningococcal and pneumococcal meningitis. 

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. 

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. 

What are the signs and symptoms of meningitis and meningococcal septicaemia (bloodstream infection) ... 

Patients with meningococcal meningitis should be isolated until after at least 48 hours of antibiotic therapy to prevent infection spreading to other patients. 

Knowledge of the likely pathogens (and their current local susceptibility rates to antimicrobials) in the clinical situation. Thus cephalexin may be a reasonable first choice for lower urinary tract infection (coliform organisms — depending on the prevalence of resistance locally), and benzylpenicillin for meningitis in the adult (meningococcal or pneumococcal). 

Sulfadiazine 10 h), sulfametop)nrazine 38 h) and sulfadimidine (sulfamethazine) (t) approx. 6 h, dose dependent) are available in some countries for urinary tract infections, meningococcal meningitis and other indications, but are not drugs of first choice (resistance rates are high). 

It acts by inhibiting RNA synthesis, bacteria being sensitive to this effect at much lower concentrations than mammalian cells it is particularly effective against mycobacteria that lie semidormant within cells. Rifampicin has a wide range of antimicrobial activity. Other uses include leprosy, severe Legionnaires disease (with erythromycin or ciprofloxacin), the chemoprophylaxis of meningococcal meningitis, and severe staphylococcal infection (with flucloxacillin or vancomycin). 

Casado-Hores I, Osona B, Domingo P, Barquet N. Meningococcal meningitis during penicillin therapy for meningococcemia. Clin Infect Dis 1997 25 1479. 

Meningococcal vaccine (quadrivalent polysaccharide for serogroups A, C, Y, and W-135)—Consider vaccination for persons with medical indications adults with terminal complement component deficiencies, with anatomic or functional asplenia. Other indications travelers to countries in which disease is hyperendemic or epidemic ("meningitis belt" of sub-Saharan Africa, Mecca, Saudi Arabia for Hajj). Revaccination at 3-5 years may be indicated for persons at high risk for infection (e.g., persons residing in areas in which disease is epidemic). 

Prophylaxis may be used to protect healthy persons from acquisition of or invasion by specific microorganisms to which they are exposed. Successful examples of this practice include rifampin administration to prevent meningococcal meningitis in close contacts of a known case, prevention of gonorrhea or syphUis after contact with an infected person, and the intermittent use of trimethoprim-sulfamethoxazole to prevent recurrent urinary tract infections. 

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