Information ⬇
- Because of the increased prevalence of resistant pneumococci, first-line therapy should include vancomycin (1 g IV q12h) plus a third-generation cephalosporin (ceftriaxone, 2 g IV q12h; or cefotaxime, 2 g IV q4h). Rifampin (600 mg/d) can be substituted for the third-generation cephalosporin in pts hypersensitive to β-lactam agents.
- The antibiotic regimen should be adjusted appropriately once susceptibility data are available. If the isolate is resistant to penicillin and cephalosporins, both vancomycin and the cephalosporin should be continued.
- A repeat LP should be considered after 48 h if the organism is not sensitive to penicillin and information on cephalosporin sensitivity is not yet available, if the pt's clinical condition does not improve or deteriorates, or if the pt has received dexamethasone, which may compromise clinical evaluation.
- In adults with community-acquired bacterial meningitis, dexamethasone should be given before or in conjunction with the first dose of antibiotics, as glucocorticoids have been demonstrated to significantly reduce rates of mortality, severe hearing loss, and neurologic sequelae. The data are not clear as to whether this practice is also beneficial in children.
Outline ⬆
Section 7. Infectious Diseases
- 78. Infections Acquired in Health Care Facilities
- 79. Infections in the Immunocompromised Host
- 80. Infective Endocarditis
- 81. Intraabdominal Infections
- 82. Infectious Diarrheas
- 83. Sexually Transmitted and Reproductive Tract Infections
- 84. Infections of the Skin, Soft Tissues, Joints, and Bones
- 85. Pneumococcal Infections
- 86. Staphylococcal Infections
- 87. Streptococcal/Enterococcal Infections, Diphtheria, and Infections Caused by Other Corynebacteria and Related Species
- 88. Meningococcal and Listerial Infections
- 89. Infections Caused by Haemophilus, Bordetella, Moraxella, and HACEK Group Organisms
- 90. Diseases Caused by Gram-Negative Enteric Bacteria and Pseudomonas
- 91. Infections Caused by Miscellaneous Gram-Negative Bacilli
- 92. Anaerobic Infections
- 93. Nocardiosis, Actinomycosis, and Whipple's Disease
- 94. Tuberculosis and Other Mycobacterial Infections
- 95. Lyme Disease and Other Nonsyphilitic Spirochetal Infections
- 96. Rickettsial Diseases
- 97. Mycoplasma Pneumoniae, Legionella Species, and Chlamydia Pneumoniae
- 98. Chlamydia Trachomatis and C. Psittaci
- 99. Herpesvirus Infections
- 100. Cytomegalovirus and Epstein-Barr Virus Infections
- 101. Influenza and Other Viral Respiratory Diseases
- 102. Rubeola, Rubella, Mumps, and Parvovirus Infections
- 103. Enteroviral Infections
- 104. Insect- and Animal-Borne Viral Infections
- 105. HIV Infection and AIDS
- 106. Fungal Infections
- 107. Pneumocystis Infections
- 108. Protozoal Infections
- 109. Helminthic Infections and Ectoparasite Infestations