Meningitis

Infectious Disease Society of America

• Practice guidelines for management of bacterial meningitis 

Emergency Care BC

• Overview of management of meningitis including pathophysiology, expected presentation and treatment recommendations

1. Which of the following is NOT among the three most common pathogens in bacterial meningitis?

a) S. pneumoniae

b) N. meningitidis

c) H. influenzae

d) Listeria monocytogenes

2. In bacterial meningitis, which of the following laboratory findings is expected in the cerebrospinal fluid (CSF)?

a) Clear appearance 

b) Elevated glucose

c) Elevated protein

d) Low opening pressure

3. Which of the following patients should receive dexamethasone therapy? 

a) An adult with N. meningitidis meningitis 

b) All children (<23 months)

c) An adult with H. influenzae meningitis 

d) An adult with S. pneumoniae meningitis

4. You have a 25-year-old patient (no risk factors) presenting with bacterial meningitis. What is the recommended empiric treatment regimen? 

a) Ampicillin + cefotaxime 

b) Cefepime + ampicillin 

c) Cefotaxime + vancomycin

d) Cefotaxime + ampicillin.+ vancomycin

5. You have a patient with bacterial meningitis on empiric regimen of cefotaxime + vancomycin. Your C&S results are back, and the patient has S. pneumoniae meningitis. MIC values are as follows: Penicillin MIC = 0.2 μg/mL & cephalosporin MIC = 0.1 μg/mL. What is the patients new recommended treatment regimen? 

a) Continue cefotaxime + vancomycin 

b) Continue cefotaxime and discontinue vancomycin

c) Continue vancomycin and discontinue cefotaxime 

d) Switch to ampicillin 

6. You have a patient with N. meningitidis. What is recommended for chemoprophylaxis and who should receive treatment? 

a) Chemoprophylaxis is not indicated 

b) Rifampin 600 mg PO BID x 2 days for patient and close contacts

c) Rifampin 600 mg PO BID x 2 days for patient only 

d) Dexamethasone 10 mg IV q6h x 2 days for patient and close contacts