Untitled

<aside>

Presentation

HPI

• Acute, rapid progression

PP/PN (Classic Triad)

• !Neck stiffness (inability to flex)
• Fever
• photophobia,

Additional

• Headache (shaking head wrosen headache)
• Constitutional symptom
• N/V - Nausea/vomitting
• Confusion
• (Rare) !Seizure

Signs

Meningeal signs

</aside>

Initial Work-up

• LP - Lumbar Puncture (Pa<25) → CSF Analyses 8-10 cc, for cell count, differential, chemistry, microbiology

Therapy

CTX - Ceftriaxone (3 gen IV) + Vancomycin + Ampicilin

Do BEFORE CT or LP

• CTX - Ceftriaxone (3 gen IV) 2g IV q12h
  • Active against H. influenzae, N. meningitidis and most isolates of S. pneumoniae
• Vancomycin 1-2g IV Q12h
  • cover resistant S. pneumoniae
• Dexamethasone (reduce brain inflammation, hearing loss from S. pneumoniae)
• • Ampicilin (if suspect Listeria monocytogenes ), also target GBS in peds
• • Ceftazidime (3 gen, IV/IM) / Meropenem (if suspect P. aeruginosa, GNB, CNST)
• • Acyclovir (if suspect HSV)

In case of Life-threatening beta-lactem allergy:

• Streptococcus pneumnonia → Vancomycin
• Listeria monocytogenes → TMP-SMX (Septra)