Makindo Medical Notes

Central Nervous System (CNS) Infections

CNS infections require urgent diagnosis and treatment to prevent severe complications or mortality. The choice of antimicrobial therapy should be guided by the likely pathogens, patient history, and clinical setting.

Meningitis - Community Acquired

• Likely Causes: Neisseria meningitidis and Streptococcus pneumoniae are the most common, with other organisms being rare.
• Overview: Meningitis is a medical emergency. Early antibiotic therapy is critical and can be life-saving.
• Initial Steps:
  • Collect cerebrospinal fluid (CSF) if a lumbar puncture (LP) is not contraindicated, blood cultures, blood in EDTA for polymerase chain reaction (PCR), and throat swab as early as possible.
  • Discuss with a Consultant Microbiologist; however, do not delay treatment while waiting for guidance.
• Notification: In the UK, notify the Health Protection Agency (HPA), which will manage prophylaxis for contacts in the community.
• Initial Antibiotic Therapy: Ceftriaxone 2 g twice daily (bd) IV. Once culture and sensitivity results are available, a change to Benzylpenicillin (2.4 g every 4 hours IV) may be appropriate.
• Additional Therapy: Consider adding Amoxicillin (2 g every 4 hours IV) if Listeria is suspected (e.g., in immunocompromised patients or the elderly).
• Duration of Therapy:
  • 7 days for meningococcal meningitis
  • 10-14 days for pneumococcal meningitis
  • 14-21 days for Listeria meningitis
• Penicillin Allergy: For severe penicillin allergies, consult a Consultant Microbiologist for alternative treatment options.

Meningitis Following Head Injury/Neurosurgery and Brain Abscess

• Antibiotic Therapy: Meropenem 2 g three times daily (TDS) IV. An alternative regimen includes Ceftriaxone 2 g twice daily (bd) IV plus Metronidazole 500 mg three times daily (TDS) IV.
• Consultation: Close collaboration with microbiology and neurosurgery is advised, as surgical intervention may be required for abscess management.

Viral Encephalitis

• Antiviral Therapy: Aciclovir 10 mg/kg three times daily (TDS) IV. Typical duration of treatment is 10 days, though extended therapy (up to 21 days) may be necessary depending on the patient’s response and severity.
• Notes: HSV encephalitis is the most common viral cause and requires immediate treatment to reduce the risk of long-term neurological damage.

Important Notes

• Early Diagnosis and Management: Prompt diagnosis and initiation of treatment are essential for CNS infections to reduce mortality and improve outcomes.
• Consultation with Specialists: Always involve microbiology and relevant specialists (e.g., neurology, infectious disease) early in complex or severe cases.