Meningitis
What is Meningitis: Meningitis is an infection which causes inflammation of the membranes covering the brain and spinal cord. Non-bacterial meningitis is often referred to as "aseptic meningitis." Bacterial meningitis may be referred to as "purulent meningitis."
Meningitis is an acute inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. The most common symptoms are fever, headache, and neck stiffness. Other symptoms include confusion or altered consciousness, vomiting, and an inability to tolerate light or loud noises. Young children often exhibit only nonspecific symptoms, such as irritability, drowsiness, or poor feeding. If a rash is present, it may indicate a particular cause of meningitis; for instance, meningitis caused by meningococcal bacteria may be accompanied by a characteristic rash.
Symptoms of meningitis
Symptoms of meningitis develop suddenly and can include:
- a high temperature (fever) of 38'C (100.4F) or above
- being sick
- a headache
- a blotchy rash that doesn't fade when a glass is rolled over it (this won't always develop)
- a stiff neck
- a dislike of bright lights
- drowsiness or unresponsiveness
- seizures (fits)
These symptoms can appear in any order and some may not appear.
Meningitis is usually caused by a viral or bacterial infection.
Viral meningitis is the most common and least serious type. Bacterial meningitis is rare but can be very serious if not treated.
Several different viruses and bacteria can cause meningitis, including:
- meningococcal bacteria – there are several different types, called A, B, C, W, X, Y and Z
- pneumococcal bacteria
- Haemophilus influenzae type b (Hib) bacteria
- enteroviruses – viruses that usually only cause a mild stomach infection
- the mumps virus
- the herpes simplex virus – a virus that usually causes cold sores or genital herpes
A number of meningitis vaccinations provide protection against many of the infections that can cause meningitis.
How meningitis is spread?
Meningitis is usually caused by a bacterial or viral infection. Bacterial meningitis is rarer but more serious than viral meningitis.
Infections that cause meningitis can be spread through:
- sneezing
- coughing
- kissing
- sharing utensils, cutlery and toothbrushes
Meningitis is usually caught from people who carry these viruses or bacteria in their nose or throat but aren't ill themselves.
It can also be caught from someone with meningitis, but this is less common.
Drugs used to treat Meningitis
Vancomycin
Vancomycin is an antibiotic. When taken by mouth it fights bacteria in the intestines.
Vancomycin is used to treat an infection of the intestines caused by Clostridium difficile, which can cause watery or bloody diarrhea. It is also used to treat staph infections that can cause inflammation of the colon and small intestines.
Oral vancomycin works only in the intestines. This medicine is not normally absorbed into the body and will not treat other types of infection. An injection form of this medication is available to treat serious infections in other parts of the body.
Vancomycin side effects
Get emergency medical help if you have any of these signs of an allergic reaction to vancomycin: hives; difficult breathing; swelling of your face, lips, tongue, or throat.
Certain side effects may occur if your body absorbs vancomycin through the intestinal walls. Call your doctor at once if you have:
- increased diarrhea that is watery or bloody;
- hearing loss, ringing in your ears;
- kidney problems--swelling, rapid weight gain, pain in your side or lower back, little or no urinating; or
- low potassium--confusion, uneven heart rate, extreme thirst, increased urination, leg discomfort, muscle weakness or limp feeling.
Common vancomycin side effects may include:
- nausea; or
- stomach pain.
Usual Adult Dose of Voncomycin for Meningitis
IDSA, American Academy of Neurology (AAN), American Association of Neurological Surgeons (AANS), and Neurocritical Care Society (NCS) Recommendations:
30 to 60 mg/kg IV per day, given in divided doses every 8 to 12 hours
-Some experts recommend: 15 mg/kg IV once, followed by 60 mg/kg per day continuous infusion
-Maximum dose: 2 g/dose
-Duration of treatment: At least 2 weeks
Comment: Surgical evaluation is recommended for patients with septic thromboses, empyema, and/or abscesses.
Uses:
-Treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-resistant staphylococci
-In combination with a third-generation cephalosporin, treatment of patients with healthcare-associated ventriculitis and meningitis caused by Streptococcus pneumoniae
-Alternative treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-sensitive staphylococci or P acnes
-Treatment of patients with brain abscess, subdural empyema, and/or spinal epidural abscess
-Treatment of patients with septic thrombosis of cavernous/Dural venous sinus.
30 to 60 mg/kg IV per day, given in divided doses every 8 to 12 hours
-Some experts recommend: 15 mg/kg IV once, followed by 60 mg/kg per day continuous infusion
-Maximum dose: 2 g/dose
-Duration of treatment: At least 2 weeks
Comment: Surgical evaluation is recommended for patients with septic thromboses, empyema, and/or abscesses.
Uses:
-Treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-resistant staphylococci
-In combination with a third-generation cephalosporin, treatment of patients with healthcare-associated ventriculitis and meningitis caused by Streptococcus pneumoniae
-Alternative treatment of patients with healthcare-associated ventriculitis and meningitis caused by methicillin-sensitive staphylococci or P acnes
-Treatment of patients with brain abscess, subdural empyema, and/or spinal epidural abscess
-Treatment of patients with septic thrombosis of cavernous/Dural venous sinus.
Bactrim
Bactrim contains a combination of sulfamethoxazole and trimethoprim. Sulfamethoxazole and trimethoprim are are both antibiotics that treat different types of infection caused by bacteria.
Bactrim is used to treat ear infections, urinary tract infections, bronchitis, traveler's diarrhea, shigellosis, and Pneumocystis jiroveci pneumonia.
BACTRIM is contraindicated in pediatric patients less than 2 months of age.
Urinary Tract Infections and Shigellosis in Adults and Pediatric Patients, and Acute Otitis Media in Children:
Adults: The usual adult dosage in the treatment of urinary tract infections is 1 BACTRIM DS (double strength) tablet or 2 BACTRIM tablets every 12 hours for 10 to 14 days. An identical daily dosage is used for 5 days in the treatment of shigellosis.
Children: The recommended dose for children with urinary tract infections or acute otitis media is 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days. An identical daily dosage is used for 5 days in the treatment of shigellosis. The following table is a guideline for the attainment of this dosage:
| Weight | Dose–every 12 hours | |
|---|---|---|
| lb | kg | Tablets |
| 22 | 10 | – |
| 44 | 20 | 1 |
| 66 | 30 | 1½ |
| 88 | 40 | 2 or 1 DS tablet |
For Patients with Impaired Renal Function: When renal function is impaired, a reduced dosage should be employed using the following table:
| Creatinine Clearance (mL/min) | Recommended Dosage Regimen |
|---|---|
| Above 30 | Usual standard regimen |
| 15–30 | ½ the usual regimen |
| Below 15 | Use not recommended |
Acute Exacerbations of Chronic Bronchitis in Adults:
The usual adult dosage in the treatment of acute exacerbations of chronic bronchitis is 1 BACTRIM DS (double strength) tablet or 2 BACTRIM tablets every 12 hours for 14 days.
Pneumocystis Jiroveci Pneumonia:
Treatment: Adults and Children:
The recommended dosage for treatment of patients with documented Pneumocystis jiroveci pneumonia is 75 to 100 mg/kg sulfamethoxazole and 15 to 20 mg/kg trimethoprim per 24 hours given in equally divided doses every 6 hours for 14 to 21 days.11 The following table is a guideline for the upper limit of this dosage:
| Weight | Dose–every 6 hours | |
|---|---|---|
| lb | kg | Tablets |
| 18 | 8 | – |
| 35 | 16 | 1 |
| 53 | 24 | 1½ |
| 70 | 32 | 2 or 1 DS tablet |
| 88 | 40 | 2½ |
| 106 | 48 | 3 or 1½ DS tablets |
| 141 | 64 | 4 or 2 DS tablets |
| 176 | 80 | 5 or 2½ DS tablets |
For the lower limit dose (75 mg/kg sulfamethoxazole and 15 mg/kg trimethoprim per 24 hours) administer 75% of the dose in the above table.
Prophylaxis:
Adults:
The recommended dosage for prophylaxis in adults is 1 BACTRIM DS (double strength) tablet daily.12
Children:
For children, the recommended dose is 750 mg/m2/day sulfamethoxazole with 150 mg/m2/day trimethoprim given orally in equally divided doses twice a day, on 3 consecutive days per week. The total daily dose should not exceed 1600 mg sulfamethoxazole and 320 mg trimethoprim.13 The following table is a guideline for the attainment of this dosage in children:
| Body Surface Area | Dose–every 12 hours |
|---|---|
| (m2) | Tablets |
| 0.26 | – |
| 0.53 | ½ |
| 1.06 | 1 |
Flagyl (metronidazole)
Flagyl (metronidazole) is an antibiotic. It fights bacteria in your body.
Flagyl is used to treat bacterial infections of the vagina, stomach, skin, joints, and respiratory tract. This medication will not treat a vaginal yeast infection.
Flagyl may also be used for purposes not listed in this medication guide.
Take Flagyl for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Flagyl will not treat a viral infection such as the common cold or flu. Do not drink alcohol while you are taking Flagyl and for at least 3 days after you stop taking it. You may have unpleasant side effects such as fast heartbeats, warmth or redness under your skin, tingly feeling, nausea, and vomiting.
Trichomoniasis
In the Female
One-day treatment – two grams of FLAGYL, given either as a single dose or in two divided doses of one gram each, given in the same day.
Seven-day course of treatment – 250 mg three times daily for seven consecutive days. There is some indication from controlled comparative studies that cure rates as determined by vaginal smears and signs and symptoms, may be higher after a seven-day course of treatment than after a one-day treatment regimen.
The dosage regimen should be individualized. Single-dose treatment can assure compliance, especially if administered under supervision, in those patients who cannot be relied on to continue the seven-day regimen. A seven-day course of treatment may minimize reinfection by protecting the patient long enough for the sexual contacts to obtain appropriate treatment. Further, some patients may tolerate one treatment regimen better than the other.
Pregnant patients should not be treated during the first trimester . In pregnant patients for whom alternative treatment has been inadequate, the one-day course of therapy should not be used, as it results in higher serum levels which can reach the fetal circulation
When repeat courses of the drug are required, it is recommended that an interval of four to six weeks elapse between courses and that the presence of the trichomonad be reconfirmed by appropriate laboratory measures. Total and differential leukocyte counts should be made before and after re-treatment.
Anaerobic Bacterial Infections
In the treatment of most serious anaerobic infections, intravenous metronidazole is usually administered initially.
The usual adult oral dosage is 7.5 mg/kg every six hours (approx. 500 mg for a 70-kg adult). A maximum of 4 g should not be exceeded during a 24-hour period.
The usual duration of therapy is 7 to 10 days; however, infections of the bone and joint, lower respiratory tract, and endocardium may require longer treatment.
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