CSF INDICES IN MENINGITISConditi CELl CELL Glucose protein -Gon Type Count stainNormal Lymp 0-4 Normal - >60% B-GViral Lymp 10-2000 normal - normalBacteri Poly 1000 Low /N +al 5000 IncreaseTB L/P,M 50-5000 Low Increase often
CHEMOTHERAPY OF BACTERIAL MENINGGITISN-meningitidis BenzylpenicillinStrep.pneumoniae CefotaximeSensitive to B-lactams CeftriaxoneResistant +VancomycinH.Influenzae Cefotaxime Ceftriaxone
Treatment of pyogenicmeningitis unknown cause of1-patients with a typical meningococcal rash Benzylpenicillin 2.4 gIV.6-hourly2-Adult aged 18-50 years without meningococcal rash Cefotaxime 2 g IV.6-hourly Ceftriaxone 2g IV.12-hourly3-Patient in whome pencillin-resistant pneumococcal infection is suspected As 2 but add-Vancomycin 1g Iv,12-hourly or Rifampicin 600 mg IV.12-hourly4-Adult aged over 50 years and those in whome Listeria monocytogees infection is suspected As for 2 but add Ampicillin 2g IV.4-jourly or Co-trimoxazole5-Patients with a clear history of anaphylaxis to B-lactams Chloramphenicol 25 mg/kg IV.6-hourly plus Vancomycin 1g IV.12-hourly
Recommendations for Empirical antimicrobial therapy in adult with community-acquired meningitisPredisposing factor pathogen Drugs16-50 yr N-St-pn Vancomycin + 3rd cephalosporin>50 yrٍ St-pn, N, List Van+3rd Ceph+ AmpicillinPresence of a risk St-pn, list, Van+3rd ceph+ H-infuenzae Ampicillinwww.NEJM.ORG ,N ENGL ,Jan-2006
Chemoprophylaxis for meningococcal infectionDose it reduce the incidence of clinical disease among contact?Observational data suggest that antibiotic reduce the risk of diseaseIn adults a single dose of 500 mg ciprofloxacin or oral rifampicin 600mg(12-hourly) for 2 days.Vaccines for groups A&C but not B menigococci.
Practical points• The typical profile is lymphocytic pleocytosis(25-500 cells/uL.)• A normal or slightly elevated protein• A normal glucose concentration.• PMN pleocytosis should always promt an alternative diagnosis• In both enterovirus &HSV,PCR is the diagnostic procedure of choice