Master the board step 3

Pediatrics
Treatment
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Initial empiric treatment: Vancomycin plus either cefotaxime or ceftriaxone
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Specific treatment:
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S. pneumoniae: Penicillin or 3rd-generation cephalosporin for 10–14
days
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N. meningitidis: Penicillin for 5–7 days
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HiB: Ampicillin for 7–10 days plus IV dexamethasone
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Pretreated and no organism identified: 3rd-generation cephalosporin for
7–10 days
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Gram-negative (E. coli): Third-generation cephalosporin for 3 weeks
The following are possible complications of meningitis:
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Neurologic dysfunction, thrombosis, and mental retardation may occur,
especially if therapy is delayed
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The most common complication is hearing loss (especially with pneumococcus)
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Subdural effusion, common with HiB → seizures and persistent fever
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Meningococcus: Septic shock, disseminated intravascular coagulation,
acidosis, adrenal hemorrhage, renal and heart failure
Meningitis can be prevented with chemoprophylaxis with rifampin for N.
meningitidis and HiB but not for S. pneumoniae. Prophylaxis should be given
to all close contacts regardless.
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