A 45-year-old female is diagnosed as a case of pneumococcal meningitis. Her blood sample were sent for culture sensitivity. In the mean time best drug to sta as an empirical treatment is
Ans. d. Vancomycin + ceftriaxone Antimicrobial therapy of pneumoeoccal meningitis is initiated with a cephalosporin (ceftriaxone, cefotaxime, or cefepime) and vancomycin. "Antimicrobial therapy ofpneumococcal meningitis is initiated with a cephalosporin (ceftriaxone, cefotaxime, or cefepime) and vancomycin. For S. pneumoniae meningitis, an isolate of S. pneumoniae is considered to be susceptible to penicillin with a minimal inhibitory concentration (MIC)1.0 mg/mL. Isolates of S. pneumoniae that have cephalosporin MICs2 mg/mL are considered resistant. For meningitis due to pneumococci, with cefotaxime or ceftriaxone MICs1 mg/mL, vancomycin is the antibiotic of choice. Rifampin can be added to vancomycin for its synergistic effect but is inadequate as monotherapy because resistance develops rapidly when it is used alone. "- "A 2-week course of intravenous antimicrobial therapy is recommended for pneumococcal meningitis." "Patients with penicillin- and cephalosporin-resistant strains of S. pneumoniae who do not respond to intravenous vancomycin alone may benefit from the addition of intraventricular vancomycin. The intraventricular route of administration is preferred over the intrathecal route because adequate concentrations of vancomycin in the cerebral ventricles are not always achieved with intrathecal administration."- Antimicrobial Therapy of CNS Bacterial Infections Based on Pathogens Organism Antibiotic Neisseria meningitides Penicillin-sensitive Penicillin G or ampicillinQ Penicillin-resistant Ceftriaxone or cefotaximeQ Streptococcus pneumoniae Penicillin-sensitive Penicillin GQ Penicillin-intermediate Ceftriaxone or cefotaxime or cefepime Penicillin-resistant (Ceftriaxone or cefotaxime or cefepime) vancomycinQ Gram-negative bacilli (except Pseudomonas spp.) Ceftriaxone or cefotaximeQ Pseudomonas aeruginosa Ceftazidime or cefepime or meropenemQ Staphylococci spp. Methicillin-sensitive NafcillinQ Methicillin-resistant VancomycinQ Listeria monocytogenes Ampicillin + gentamicinQ Haemophilus influenzae Ceftriaxone or cefotaxime or cefepimeQ Streptococcus agalactiae Penicillin G or ampicillinQ Bacteroides fragilis MetronidazoleQ Fusobacterium spp. MetronidazoleQ
Penicillin G
Doxycycline
Streptomycin
Vancomycin + ceftriaxone