By Christopher Grace
This article gathers info about the analysis and administration of grownup sufferers with infections within the outpatient atmosphere. It comprises tables, algorithms, photos and diagrams to elucidate and consolidate the most important issues. every one bankruptcy gains key issues bins that summarize vital issues and aid direct services to serious details.
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Extra info for Medical Management of Infectious Disease (Clinical Guides to Medical Management)
There is increasing evidence that early initiation of corticosteroid therapy improves neurological outcome and overall mortality rate. Most of this evidence is from studies of children with H. inﬂuenzae meningitis. However, it is clear to this author that corticosteroid administration before the initial antibiotic dose is associated with signiﬁcant beneﬁcial effects in patients with pneumococcal or meningococcal meningitis as well as those with H. inﬂuenzae. 4 mg/kg given twice a day for 2 days, with the ﬁrst dose administered just prior to initiation of antibiotic therapy.
Adults should receive 600 mg/day and children 1–12 years old should receive 10 mg/kg/day. An alternative drug is minocycline at 100 mg, also administered twice a day for 2 days. Recent studies, however, have found that a single dose of ciproﬂoxacin 500 mg is easier to administer and is effective. 4 Streptococcus pneumoniae With the remarkable fall in the numbers of cases of H. inﬂuenzae meningitis, S. pneumoniae is becoming the most common pathogen isolated in patients with meningitis. Patients with deﬁcits in humerol immunity (multiple myeloma, acquired hypogammaglobulinemia, sickle cell disease patients and postsplenectomy patients) are particularly 22 Levitz susceptible to severe pneumococcal disease including meningitis.
Between 25% and 30% of patients have a prior history of otitis media but other primary foci of disease are uncommon. Adults with H. inﬂuenzae meningitis generally have a history of chronic sinusitis or head trauma. Over the past 20 years, the introduction of new broad-spectrum cephalosporins that cross the blood–brain barrier as well as the routine use of corticosteroids have improved survival and diminished neurological sequelae rates in children with this disease. 6 Therapy Antibiotic therapy of bacterial meningitis should be guided by the results of CSF Gram stain (see Table 3).