And an older oral drug, Rifadin rifampin , as well as the less convenient, injectable-only, Rocephin ceftriaxone can be used as prophylactic treatment for those exposed to someone with meningitis. Because if you skip even one or two pills, the remaining bacteria could resist future antibiotic treatment.
Also, ask your doctor if you have all the vaccinations you need to protect yourself from meningitis and other illnesses. Vaccines are available to prevent some types of bacterial meningitis. If you stay healthy, there will be no need to take antibiotics. By subscribing you agree to the Terms of Use and Privacy Policy. Health Topics. Health Tools. Reviewed: November 5, Medically Reviewed.
What Are Antibiotics? Once a negative CT scan result is obtained, patients can proceed to lumbar puncture. Empiric therapy should begin as soon as bacterial meningitis is thought likely. Widespread resistance to penicillins and sulfonamides has forced a consideration of new agents for the treatment of bacterial meningitis, such as cephalosporins, vancomycin Vancocin , rifampin Rifadin , carbapenems, and fluoroquinolones.
The addition of dexamethasone also should be considered. Adjunctive dexamethasone can reduce the subarachnoid space inflammatory response—a major factor in morbidity and mortality caused by bacterial meningitis—and may therefore alleviate many of the pathologic consequences of bacterial meningitis e.
There is some concern that adjunctive dexamethasone therapy may inhibit the efficacy of cerebrospinal fluid CSF vancomycin and would therefore be harmful to patients with penicillin- or cephalosporin-resistant strains. However, in the absence of data from clinical trials, adjunctive dexamethasone is recommended for all adults with suspected or proven pneumococcal meningitis, and in infants and children with Haemophilus influenzae type b meningitis A-I , even if the isolate subsequently is found to be highly resistant to penicillin or a cephalosporin.
Patients should be observed closely in follow-up to check for any adverse outcomes. Recommended dosage of dexamethasone is 0. Patients receiving adjunctive dexamethasone for the treatment of suspected pneumococcal meningitis may benefit from the addition of rifampin to the combination of vancomycin and a third-generation cephalosporin.
The use of dexamethasone in infants and children with pneumococcal meningitis is controversial, and there are insufficient data to support its use in neonates or in adults with meningitis caused by other pathogens.
Patients who already have received antimicrobial therapy should not be given dexamethasone therapy, as it is unlikely to improve their outcome A-I.
Dexamethasone therapy should be continued following test results only if gram-positive diplococci are found in the CSF Gram stain, or if cultures reveal Streptococcus pneumoniae.
Diagnosis of bacterial meningitis is dependent on CSF examination following lumbar puncture. In bacterial meningitis, opening pressure generally is between and mm H 2 O lower in children ; white blood cell count and protein concentration are elevated; glucose concentration may be low; and there may be a neutrophil or lymphocyte predominance. Because determining the bacterial etiology can take up to 48 hours with CSF cultures, an alternative diagnostic test should be considered.
It is fast, inexpensive, and accurate in 60 to 90 percent of patients, although misinterpretation and contamination may cause false-positive results.
Polymerase Chain Reaction PCR is useful for excluding a diagnosis of bacterial meningitis and may eventually, with further refinement, be used for determining etiology B-II.
Latex agglutination, while quick, simple, and sensitive, is not recommended for routine use as pathogens cannot be ruled out by a negative test result D-II. It is most useful for patients who have begun therapy and have negative Gram stain and CSF culture results. Limulus lysate assay, though sensitive, also is not recommended for routine use D-II as it does not distinguish between organisms or rule out gram-negative meningitis, and it is not widely available.
When CSF findings suggest bacterial meningitis but CSF Gram stain and culture results are negative, a combination of laboratory tests is necessary to distinguish bacterial from viral meningitis. Although there is a validated CSF result model, its clinical utility has not yet been proven, and it should not be used to determine initiation of antimicrobial therapy. The most strongly recommended tests are PCR, which is more sensitive than viral culture and faster than cell culture for the detection of enterovirus, and determination of C-reactive protein CRP concentration, which has a high negative predictive value for bacterial meningitis when results are normal B-II.
Lactate concentration is not recommended D-III since results generally are nonspecific and may be confounded by other factors although a CSF lactate concentration of 4. Procalcitonin concentration measurement is useful, but cannot be recommended until it becomes more widely available C-II. Targeted antimicrobial therapy can begin in adults following a positive CSF Gram stain result.
Note that empiric antibiotic therapy should not be delayed pending the results of Gram stain or other diagnostic tests. Children should not be given targeted therapy until blood culture results confirm the diagnosis, since CSF Gram stain interpretation is subject to expertise.
In the meantime, they should receive empiric therapy with vancomycin plus either ceftriaxone Rocephin or cefotaxime Claforan. Patients whose Gram stain result is negative also should continue with empiric therapy. Antimicrobial therapy should be modified as soon as the pathogen has been isolated and in vitro tests have been performed. Duration of therapy depends on individual patient response, though generalized guidelines according to the responsible pathogen are as follows: Neisseria meningitidis or H.
And without that happening, everyone has to worry. In an effort to jumpstart and guide the research and development of new antibiotics, WHO published a list of 12 types of bacteria for which new antibiotics are most urgently needed. Many of the bacteria included in the list compiled by WHO can cause bacterial meningitis and septicaemia. Because of this rising threat, never before has it been more important to prevent meningitis from happening in the first place.
This means vaccines. Affordable vaccines, targeted at people who need them most. We have many of these vaccines right now and they are already proving their worth in preventing disease. Not only do vaccines prevent people getting ill, but they can also impact on antibiotic resistance. Gaps in vaccine coverage will mean that effective diagnosis and treatment of meningitis are always essential parts of the health toolkit. And that of course means antibiotics. Antibiotics become less useful as more people use them badly.
Using antibiotics for a virus is pointless. Not finishing a course of antibiotics means the bug can come back even stronger. Doing both - as frequently happens - is like training bacteria to get smarter and more deadly. Meningitis Research Foundation considers this issue - known as antimicrobial resistance - to be a major emerging threat to the progress that has been seen in the past 20 years in the fight against this awful disease.
It will affect people globally. And it will need a global change of direction towards more effective vaccination programmes and better use of antibiotics to deal with it.
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