Pneumonia? Meningitis?

[Ilovelamp5]

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Hi Everyone,

I take boards in two days, and still cannot figure out the consensus on how to treat meningitis and pneumonias in different age groups? I have seen three different combinations in three different books.

Any advice?

Thanks!

 

[QuinnB]

the main trouble I have is what is the cutoff when meningococcus becomes your number 1; I have heard age 4, 6 or 12. Basically I'm looking for the characteristic rash to clinch that one. Otherwise it is likely pneumococcus in older people (out of college until they are seniors) and little kids (age 6 months to age 4, 6 or 12). For infants I'm going with GBS, even though everyone is now saying that it is E coli b/c of all of the prophylaxis (I don't think the boards have caught on to this yet).

This has bothered me too.

 

[werd]

i guess i would go with whatever book is most recent... you can't really trust old sources for abx tx, as PCN used to nuke everything in sight. what i've learned is empiric ceftriaxone/vanc (mc, s.pneumo, h.flu) for most, amp+gent for infants (e.coli, gbs, listeria), and ceftriaxone/vanc/amp for elderly (typical plus listeria). the vanc thing sort of depends on local s.pneumo resistance to ceftriaxone and probably isn't testable in my opinion.

pneumonia is more complicated and a number of strategies are prob appropriate. typically azithro for the young/not that sick person, newer FQ's for the sicker CAP, FQ or ceftriaxone+azithro if you admit them, gm negative coverage for hosp. acquired, anaerobic coverage for aspiration risks, etc etc. frankly, i don't think abx dilemmas are really stressed on the boards. maybe something like choosing between cipro and ceftriaxone, but not ceftriaxone vs. moxiflox for a pneumonia. i'd worry more about what abx can't be used in kids or the elderly and side-effects. werd.

 

[Ilovelamp5]

Thanks so much for the help! I take it tomorrow, so keep your fingers crossed for me 🙂

 

[exgatr]

Remember too that the actual test doesnt make you choose between antibiotics. It gives you a list of drugs & only one is an antibiotic, so choose that one.

 

[werd]

Remember too that the actual test doesnt make you choose between antibiotics. It gives you a list of drugs & only one is an antibiotic, so choose that one.

there were multiple questions on my step2 about which antibiotics to chose.

 

[JayneCobb]

If anyone wants the actual up-to-date reccomendations from the people who know. Go to the IDSA's website