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Medicine

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Neurology

Question
17 out of 18
 

Drug of choice in treatment of acute bacterial Meningitis? (AIIMS May 2014)



A Ceftriaxone
B Penicillin G

C Ceftazidime
D Ampicillin

Ans. A

Ceftriaxone

TREATMENT – (Ref. Hari-18th ed., Table 381.3 Pg- 3416)

1). Empirical therapy Third generation cephalosporin and vancomycin

2). N. Meningitidis (7 day) Penicillin G/ Ampicillin, ceftriaxone/ cefotaxime

3). Str. Pneumoniae (14 day) Penicillin G, Vancomycin + ceftriaxone

4). Gm negative (21day) Ceftriaxone/ cefotaxime

5). Pseudomonas Ceftazidime

6). Staphylococci Nafcillin, Vancomycin

7). Listeria (21 day) Ampicillin

8). H. influenza Ceftriaxone / cefotaxime

Important Points Role of:I/V Dexamethasone –

1). Used in Meningitis due to H. influenza and str. pneumonia in children (0.6mg/kg/d) for 2 – 4 days

2). It decrease meningeal inflammation

3). Decrease Neurological sequelae like hearing loss.

Extra Edge:Treatment of Raised ICT

1). Elevation of head to 30 – 450

2). Hyper ventilation

3). Mannitol

Treatment of Cryptococcosis:

Neural (Meningo-encephalitis)

Amphotericin B ± Flucytosine for 2 weeks, followed by Fluconazole (oral) OD

Extraneural

Amphotericin B ± Flucytosine

Extra Edge:Amphotericin B is the drug of choice for Cryptococcosis

Extra Edge:Neoplastic Meningitis: (Ref. Hari-18th ed., pg- 2271)

1). Tumor involving the leptomeninges is a complication of both primary CNS tumors and tumors that metastasize to the CNS.

2). Melanoma, breast and lung cancer, lymphoma (including AIDS-associated), and acute leukemia are the most common causes.

3). Diagnosis is made by demonstrating malignant cells in the CSF; (Up to 40% of patients may have false-negative CSF cytology).

4. An elevated CSF protein level is nearly always present (except in HTLV-1–associated adult T cell leukemia).

5). MRI findings suggestive of neoplastic meningitis include leptomeningeal, subependymal, dural, or cranial nerve enhancement; superficial cerebral lesions; and communicating hydrocephalus.

Neurology Flashcard List

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