treatment of meningitis including supportive measures and pharmacological approach prophylaxis of means by chemo or immuno

1. Treatment and
Prophylaxis
NurAmalina bt.
Aminuddin Baki
60

2. Objectives
• Treatment:
– Supportives measures
– Drugs
• Prophylaxis:
– Chemoprophylaxis
– immunoprophylaxis

3. Introduction
Bacterial Meningitis
• More severe
• Requires treatment
• Available vaccine present
Viral Meningitis
• Less severe
• Supportives measures
• Self -limited

4. Recommended Empiric Antibiotics
for Suspected Bacterial Meningitis
Age or Predisposing Feature Antibiotics
Age 0-4 wk Ampicillin plus either cefotaxime or an
aminoglycoside
Age 1 mo-50 y Vancomycin plus cefotaxime or ceftriaxone
Age >50 y Vancomycin plus ampicillin plus ceftriaxone
or cefotaxime plus vancomycin
Impaired cellular immunity Vancomycin plus ampicillin plus either
cefepime or meropenem
Recurrent meningitis Vancomycin plus cefotaxime or ceftriaxone
Basilar skull fracture Vancomycin plus cefotaxime or ceftriaxone
Head trauma, neurosurgery, or CSF shunt Vancomycin plus ceftazidime, cefepime, or
meropenem

5. Bacterial Meningitis
• Neisseria meningitidis
• B,C,Y serogroup = developed region
• A, w-135 serogroup = less developed region
Treatment Prevention
•Penicillin
/chloramphenicol
•Ciprofloxacin / Rifampicin
for close contacts
•Meningococcal vaccine

6. Meningococcal Vaccine
• Quadrivalent (A,C , W-
135, Y)
– MCV-4 (9m-55y)
– MPSV-4
• Elderly (>55 years old)
• Last for 3 year
• Bivalent (C,Y):
– infant >6w
– to prevent meningitis
C ,Y and HiB disease
• Serogroup A:
MenAfriVac
• Serogroup B : difficult
as too similar to neural
antigen
•11-18y •HIV adolescent •>16y
•Two
doses
1: 11-
12y
2: 16y
•Three doses
2 doses 2 months
apart at 11-12y
Booster : 16y
•X
booster
dose

7. • Haemophilus influenzae
Treatment Prevention
•ceftriaxone or cefotaxime
•Ampicillin,
•Rifampicin X 4 days for
close contact
•Hib PRP vaccine

8. HiB PolyribosylRibitolPhosphate
Vaccine
• Polysaccharide: limited usefulness
• Conjugate:
– Tetanus toxoid, diphteria toxoid, N. meningitidis
OMP
– >2 months ( 2 doses at 2 month interval)
• Combination
– Hib + DPT in USA

9. • Streptococcus pneumoniae
Treatment Prevention
•Penicillin
• ceftriaxone / cefotaxime
•Vancomycin
•PPSV23
•PCV13
•PCV7

10. Pneumococcal Vaccine
• Polysaccharide : PPSV23
For increased risk group
o Dysfunctional spleen,
nephrotic synd., sickle cell
anemia, multiple myeloma,
DM, immunodeficiency
patient.
Single dose injection , last 5
years
(-): <2 years old, not lifelong
• Conjugated:
PCV13 children at 2, 4,
6, and 12–15 months old
PCV7 bind to diphteria
toxoid
o 2-23months
o Increased risk in 2-5 years
old

11. • Mycobacterium tuberculosis
Isoniazid
• Only in risk groups( 5mg/kg daily X 6-12M)
 Unavoidable contact with patient with open TB
 Children which is tuberculin +ve but radiology clear
 adult with radiological evidence of inactive disease
Treatment Prevention
•Isoniazid (H),rifampin (R),
pyrazinamide (Z) ,
,streptomycin(E)
•Isoniazid
•BCG vaccination

12. Bacille Calmette Guerin Vaccine
• Strain of M bovis weakened by 239 serial
subculture in glycerine- bile- potato medium
(13 ears)
• 0.1ml ID  small nodule (2-3w)
• Given soon after birth
• Complications :
Local : abscess, keloid formation
Regional: lymphadenitis
General: fever , erythema nodosum

13. • Escherichia coli and group B
streptococci
• Listeria monocytogenes
Treatment Prevention
•Gentamicin + cefotaxime
or ceftriaxone (or
chloramphenicol)
•No vaccines available
Treatment Prevention
Penicillin or ampicillin +
gentamicin
No vaccines available

14. Viral Meningitis
• Self-limited, offer supportive measures
o Herpes simplex virus
o Mumps
o Lymphocytic choriomeningitis
o Enteroviruses including coxsackievirus, echovirus
and poliovirusPicornaviruses
o Japanese encephalitis
o HIV
• Complete recovery

15. Fungal Meningitis
• Cryptococcus neoformans
• Coccidioides immitis
Treatment Prevention
•Amphotericin B and
flucytosine
•No vaccines available
Treatment Prevention
•amphotericin B,
fluconazole or
miconazole
•No vaccines available

16. Protozoal Meningitis
Treatment
•not fully satisfactory
Naegleria :Amphotericin B, with miconazole and
rifampin
Balamuthia mandrillaris :albendazole and
itraconazole

17. Conclusion
Pathogen Prevention
•Neisseria
meningitidis
•MCV-4
•MPSV-4
•Haemophilus
influenzae
•Hib vaccine
•Streptococcus
pneumoniae
•PPSV23
•PCV13
•PCV7
•Mycobacterium
tuberculosis
•BCG vaccination

18. Reference
• Richard V. Goering, Hazel M. Dockrell, Mark
Zuckerman, Peter L. Chiodini, and Ivan M.
Roitt, Mims’ Medical Microbiology,5th
edition
• Ananthanarayan and Paniker , Textbook of
Microbiology, 8th
edition
• Prof CP Baveja, Textbook of Microbiology, 2nd
edition
• http://www.cdc.gov/vaccines