During Noon Rounds on Friday, we discussed the importance of recognizing and treating bacterial meninigits, a diagnosis that still carries with it a case-fatality rate of 16.4%! (Please visit this link to connect you to the 2007 NEJM article detailing surveillance data on culture-confirmed cases of bacterial meningitis in the United States from 1998-2007).
To review, the classic triad consists of: fever, nuchal rigidity, and altered mental status. Remember, many patients do not present with all three features, but most will present with at least one.
Jolt accentuation of headache is the most sensitive maneuver for detecting meningitis.
The common culprit bugs include Streptococcus pneumoniae, Neisseria meningitidis, and, primarily in patients over age 50 or those who have deficiencies in cell-mediated immunity, Listeria monocytogenes.
Knowing this, first-line empiric antimicrobial therapy consists of:
1) ceftriaxone 2 g iv q12h
2) vancomycin 1 g iv q8h
3) ampicillin 2 g iv q4h (in those patients where Listeria monocytogenes is a consideration)
In those patient's where Streptococcus pneumoniae meningitis is a consideration, give dexamethasone 0.15 mg/kg iv q6h for four days, with the first dose given 15-20 minutes prior to or at the time of antibiotic administration.
Please visit the following link to view the Infectious Diseases Society of America Clinical Practice Guidelines on the Management of Bacterial Meningitis.
