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Neuro antibiotics
From WikEM
Contents
- 1 Bell's Palsy
- 2 Brain abscess
- 3 Encephalitis
- 4 Epidural Abscess
- 5 Meningitis
- 5.1 Neonates (up to 1 month of age)[5]
- 5.2 > 1 month old[6]
- 5.3 Adult < 50 yr[7]
- 5.4 Adult > 50 yr and Immunocompromised[8]
- 5.5 Post Procedural (or penetrating trauma)[10]
- 5.6 Cryptococcosis Meningitis
- 5.7 Meningitis with severe PCN allergy
- 5.8 Meningitis with VP shunt
- 5.9 Neisseria meningitidis Prophylaxis
- 6 Tetanus
- 7 See Also
- 8 References
Bell's Palsy
Steroids
- Prednisone 60-80mg qday x1wk[1] (Level B Evidence)[2]
- Steroids should be started within 72hrs of symptoms[3]
Antivirals
- Most likely no added benefit when combined with steroids. However also little harm associated with antivirals especially in patients with normal renal function[2]
- Valacyclovir 1000mg TID x1wk[1] OR
- Acyclovir 400mg 5x per day x 1wk
Brain abscess
Otogenic source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
Sinogenic or odontogenic source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
Penetrating trauma or neurosurgical procedures
- Vancomycin 15mg/kg IV q12hr + ceftazidime 2gm IV q8hr
Hematogenous source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
No obvious source
- Cefotaxime 2gm IV q6hr + metronidazole 500mg IV q6hr
Encephalitis
often it is unclear which type of encephalitis is present and starting Acyclovir empirically is appropriate
HSV encephalitis
- Acyclovir 10mg/kg every 8hrs
HZV encephalitis
- Acyclovir 10mg/kg every 8hr
CMV encephalitis
- Ganciclovir 5mg/kg IV every 12hr OR
- Foscarnet 90mg/kg IV every 12 hrs
Epidural Abscess
- Target Staph, Strep, and Gram-negative bacilli[4]
- Vancomycin 15-20mg/kg BID + metronidazole 500g (7.5mg/kg) q6 hrs + (Cefotaxime or Ceftriaxone or Ceftazidime)
- Ceftazidime is preferred if pseudomonas is considered likely
- Can substitute Nafcillin or Oxacillin for Vancomycin if not MRSA
Treat for 6-8 weeks
Meningitis
Neonates (up to 1 month of age)[5]
MRSA is uncommon in the neonate
- Ampicillin 50mg/kg IV q6hrs PLUS
- Cefotaxime 50mg/kg IV q6hrs OR Gentamicin 2.5mg/kg IV q8hrs
- If suspecting S. pneumoniae or MRSA, add Vancomycin
- Consider acyclovir for HSV
> 1 month old[6]
- Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
- Vancomycin 15-20 mg/kg IV BID daily
- Vancomycin is for resistant Pneumococcus
Adult < 50 yr[7]
- Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
- Vancomycin 15-20 mg/kg IV BID daily
- Vancomycin is for resistant Pneumococcus
Adult > 50 yr and Immunocompromised[8]
- Ceftriaxone 2gm (50mg/kg) IV BID daily PLUS
- Vancomycin 15-20 mg/kg IV BID daily PLUS
- Ampicillin 2gm IV q4h (hourly if listeria suspected)[9]
Post Procedural (or penetrating trauma)[10]
- Vancomycin 15-20mg/kg IV BID daily PLUS
- Cefepime 2g (50mg/kg) IV q8 hours daily OR Ceftazidime 2g (50mg/kg) IV q8 hours daily OR Meropenem 2gm (40mg/kg) IV q8 hours daily
Cryptococcosis Meningitis
Options
- Amphotericin B 1mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
- Amphotericin B 5mg/kg IV once daily AND Flucytosine 25mg/kg PO q6hrs daily
Meningitis with severe PCN allergy
- Chloramphenicol 1g IV q6h + Vancomycin 15mg/kg q8-12hr
Meningitis with VP shunt
- Coverage for skin contaminants (S. epidermis, S. aureus)
- Vancomycin plus ceftriaxone plus shunt removal
Neisseria meningitidis Prophylaxis
- Ceftriaxone 250mg IM once (if less than 15yr then 125mg IM)
- Ciprofloxacin 500mg PO once
- Rifampin 600 mg PO BID x 2 days
- if < 1 month old then 5mg/kg PO BID x 2 days
- if ≥ 1 month old then 10mg/kg (max at 600mg) PO BID x 2 days
Tetanus
- 500 mg IV every 6 hours
(<1200g)
- 7.5 mg/kg PO/IV q48h
- First Dose: 7.5 mg/kg PO/IV x 1
(>1200g AND <1 Month Old)
- <7 days old
- 7.5-15 mg/kg/day PO/IV q12-24h
- First Dose: 7.5-15 mg/kg PO/IV x 1
- >7 days old
- 15-30 mg/kg/day PO/IV q12h
- First Dose: 7.5-15 mg/kg PO/IV x 1
(>1 Month Old)
- 30 mg/kg/day PO/IV q6h
- First Dose: 7.5 mg/kg PO/IV x 1
- Max: 4 g/day
See Also
Antibiotics by diagnosis
- Bone and joint antibiotics
- Cardiovascular antibiotics
- ENT antibiotics
- Eye antibiotics
- GI antibiotics
- GU antibiotics
- Neuro antibiotics
- OB/GYN antibiotics
- Pulmonary antibiotics
- Skin and soft tissue antibiotics
- Bioterrorism antibiotics
- Environmental exposure antibiotics
- Immunocompromised antibiotics
- Post exposure prophylaxis antibiotics
- Pediatric antibiotics
- Sepsis antibiotics
- Arthropod and parasitic antibiotics
For antibiotics by organism see Microbiology (Main)
References
- ↑ 1.0 1.1 UpToDate. Bell's Palsy Prognosis and Treatment. March, 2014
- ↑ 2.0 2.1 Gronseth GS, Paduga R. Evidence-based guideline update: Steroids and antivirals for Bell palsy: Report of the Guideline Development Subcommittee of the American Academy of Neurology. Neurology. 2012Full Text
- ↑ Vargish L. For Bell’s palsy, start steroids early; no need for an antiviral. J Fam Pract. Jan 2008; 57(1): 22–25../docss/JFP-57-22.pdf
- ↑ Rigamonti D. et al. Spinal epidural abscess: contemporary trends in etiology, evaluation, and management. Surg Neurol 1999; 52:189-96
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
- ↑ [Guideline] Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008 Jul. 15(7):649-59.
- ↑ van de Beek D. et al. Advances in treatment of bacterial meningitis. Lancet. Nov 10 2012;380(9854):1693-702
