Links:
Meningitis:
Practice Guidelines for the Management of Bacterial Meningitis
Encephalitis:
The Management of Encephalitis: Clinical Practice Guidelines by the Infectious Diseases Society of America
| CSF Characteristics | ||||
| Bacterial | Viral | Fungal | TB | |
| Opening Pressure | Elevated | Slightly Elevated | Normal or High | Usually High |
| Glucose | Low | Normal | Low | Low |
| Protein | Very High | Normal | High | High |
| Rbcs | Few | None | None | None |
| Wbcs (c/mm3) | >200 | <200 | <50 | 20-30 |
| Diff | PMNs | Mono | Mono | Mono |
| Appearance | Turbid | Clear | Turbid | Cobweb |
MENINGITIS
| Population | Empiric treatment |
| Normal adult | Ceftriaxone 2g IV Q12 + vancomycin 15-20mg/kg IV Q12 |
| * dexamethasone 10mg IV Q6 x 4 days decreases mortality and neuro disability in S. pneumoniae. Give before or with 1st dose of antibiotics. | |
| If >50yo or alcoholic: add ampicillin 2g IV Q4 for Listeria coverage | |
| Immunosuppressed | Ampicillin + ceftazidime 2g IV Q8 + vancomycin + acyclovir |
| CSF shunt, recent neurosurgery, head trauma | Vancomycin + ceftazidime or cefepime (for Pseudomonas coverage) |
Duration of therapy based on organism: Neissureia, H. influenza: 7 days, S. pneumoniae: 14 days, Group B Strep: 14-21 days, GNR: 21 days, Listeria: >/= 21 days
ENCEPHALITIS
| Etiology | Treatment |
| Viral | HSV, VZV: acyclovir 10mg/kg |
| CMV: ganciclovir +/- goscarnet | |
| Mycobacteria | Antimycobacterial Rx + dexamethasone |
| Fungal | Amphotericin +/= 5-FU |