Severe CNS Infections are time dependent diagnoses! You must have a high index of suspicion, a good plan for your work-up, and rapid provision of treatment. After seeing a severely ill meningitis patient, I figured I would do a podcast on some tips and pearls on this topic.

When to Suspect

Here is the article I mentioned on establishing pretest prob:

http://pmid.us/15509818

What Antibiotics

Ceftriaxone 2g as empiric therapy in any suspected meningitis patient

If high risk or LP results are positive, also give

* Vancomycin 1 G

* Ampicillin 2g if age > 50 y/o

* Acyclovir 10  mg/kg if high RBC count, obtundation, seizures, or focal neurologic deficit

* Dexamethasone 10 mg

* Cefepime or Imipenem if hospitalized or neurosurgery patient

listen to the podcast for more and see the EMCrit chapter for more.

photo by Lapoland

Update:

Def. give Dex. (PMID: 12432041)