Acute Bacterial Meningitis Treatment

Acute Bacterial Meningitis

    * Introduction
    * Pathophysiology
    * Clinical
    * Diagnosis
    * Treatment
 
Treatment
Meningitis is exclusively medical treatment. Patients with bacterial meningitis should receive emergency medical treatment, initially until Fri empirical test results, then targeting the causative agent. Medical treatment is begun empirically since the hospital after being diagnosed with meningitis, and in cerebrospinal fluid are collected this time, two samples of blood and possible injury or purple spots. It is best that the two blood samples to be harvested before the establishment of empirical medical treatment, because results of the tests to be as relevant. Empirical medical schemes are established according to the most frequent etiologic agents of that region and depending on patient age. - For infants empirical therapy with ampicillin administration consists of a cephalosporin Third-generation (cefotaxime). Another scheme would be administered ampicillin plus an aminoglycoside. For infants up to 12 weeks empirical treatment consisted of ampicillin plus third-generation cephalosporin. Infants between three and six months is given a third generation cephalosporin and vancomycin (vancomycin is administered depending on the case). - The teens and young adults, aged between 15 and 25 years with the most frequent etiologic agents are Neisseria meningitidis (meningococcus) and Streptococcus pneumoniae, cefotaxime or ceftriaxone is recommended. - In adults aged 50 years to ampicillin and a cephalosporin is administered to third-generation, and sometimes add vancomycin depending on the case. - In patients who underwent neurosurgical intervention and those with cerebrospinal fluid shunts of ceftazidime plus vancomycin is administered, because in this case meningitis is caused by bacteria resistant to antibiotics regular hospital (Pseudomonas aeruginosa, staphylococci, difteroizi). After the results came from laboratory and is known etiologic agent, passing on targeted drug therapy, directed by antibiogram (causative agent of antibiotic susceptibility testing). Targeted therapy is the most expensive and less toxic antibiotic is sensitive to the causative agent, this rule is valid for all infectious diseases. By this method to avoid the development of microbial resistance to antibiotics very powerful, expensive and toxic, which thus would not be effective and would have no reserve antibiotics. Bacterial meningitis caused by Neisseria meningitidis is treated with penicillin G and ampicillin. Meningitis caused by Streptococcus pneumoniae lately acquired resistance to treatment with penicillin G, but if antibiogram indicates sensitivity to the antibiotic treatment will be followed with penicillin G. Otherwise Cefotaxime or ceftriaxone should be used. If any of these antibiotics strep is not sensitive, treatment should be instituted with vancomycin plus a third-generation cephalosporin or rifampicin, another scheme is third-generation cephalosporin or ampicillin plus either rifampin or vancomycin. Haemophilus influenzae is treatment with penicillin G or chloramphenicol. In the case of meningitis caused by Gram-negative enteric bacilli, the most effective treatment is a third generation cephalosporin. Meningitis with Gram-negative aerobic bacteria can be treated with aminoglycoside or quinolone agents (ciprofloxacin, ofloxacin, perfloxacina). For meningitis caused by Listeria monocytogenes is used ampicillin plus third-generation cephalosporin or an aminoglycoside plus ampicillin or trimethoprim-sulfamethoxazole can be used doat. Meningitis caused by Staphylococcus aureus be treated with oxacillin, nafcillin or vancomycin. Staphylococcus epidermidis meningitis occurs in patients with cerebrospinal fluid are of these patients being treated with vancomycin, and if no results are obtained by adding rifampicin. Treatment duration is variable depending on the causative agent. Thus, for meningitis caused by Neisseria meningitidis, duration of treatment is 7 days. For treatment of meningitis caused by Haemophilus influenzae lasts from 7-10 days. Streptococcus pneumoniae meningitis will be treated 10-14 days. Meningitis with Gram-negative aerobic bacteria will be treated over a period of three weeks. All antibiotics should be administered intravenously, this route with the best efficiency. As an adjunct, it will consider reducing intracranial pressure if it is too high. For this patient will be positioned with his head on a pillow to 300 and administer oxygen mask to a blood pressure of 27-30 mmHg CO2. Hyperosmolar agents may also be administered as mannitol or corticosteroids and lidocaine. In case of using glycerol dexamethasone can be given preventively to reduce auditory sequelae. Seizures be treated with diazepam or lorazepam.
Highest mortality prognosis is common in meningitis caused by Neisseria meningitidis (meningococcal), especially if antibacterial treatment is established later. The mortality rate for meningitis caused by Haemophilus influenzae is around 8%, being higher in African countries. In the case of meningitis with Gram-negative aerobes, they have a habit of relapse after a while because of the persistence of bacilli in young forms the focus of origin. Healing meningitis can occur with some neurologic sequelae, usually with a mild cognitive impairment. The deficit will translate into severe auditory deficit of speech, paralysis in different regions, seizures and behavioral disorders. Sequelae occur even more frequently as the treatment is started later, but depends on the patient's general condition before the illness. Neurological sequelae are interested about a third of patients.
Prophylaxis Vaccinand child against the causative organism of meningitis will significantly reduce its incidence in the population. Thus, between 12 and 15 months children will be vaccinated against measles, mumps and rubella. At 18 months will be vaccinated against chickenpox. Between the ages of 2 months and 5 years is recommended vaccine against Haemophilus influenzae type B. The vaccine will be made and people with weakened immune systems. Also, people imunotarate and those who travel to endemic areas (Africa) have to make vaccines against meningococcus, and Streptococcus pneumoniae. Also, we recommend avoiding contact with people suffering from meningitis, especially with their saliva and nasal secretions. People still come into contact with the product benefit from prophylactic treatment with ciprofloxacin and ceftriaxone, is taking this measure in case of repeated contact, not casual.