Question

1. An otherwise healthy 25-year-old male comes to your clinic presenting with acute bacterial meningitis. Discuss the following:
   1. Identify an antibiotic that could be used to successfully treat meningitis
   2. Briefly discuss on a cellular level how the antibiotic can disable the infection
   3. What would be the proper dosing and route of administration for the drug and why?
   4. Sometimes corticosteroids are used in conjunction to treat symptoms of bacterial meningitis, why?
   5. If our patient is allergic to penicillin would this change how we treat this case? Why or why not?
   6. Our patient develops MRSA while he’s in the hospital receiving treatment. What type of drug would we use to treat this?
   7. What would be some adverse effects we should be aware of with our initial treatment?

Answer 1

Acute bacterial meningitis is the inflammation of lining of brain and spinal cord by invasion of bacterial through blood stream to the brain.

a. An antibiotic that could be used to successfully treat meningitis is cefotaxime (Claforan) which is a β-lactam antibiotic in the third-generation class of cephalosporins.

b. Cefotaxime inhibit the bacterial cell wall biosynthesis by binding to the penicillin-binding proteins (PBPs) which disturb the cell wall formation( inhibiting cross-linking of the peptidoglycan) and lead to bacterial lysis(activation of bacterial cell autolysins) and reduce the infection.

c.In adults the recommended dose of Cefotaxime is intravenous injection 2 g every 4 to 6 hours for a duration of 7 days (for serious infections 2 grams every 6-8 hours and Life-threatening infections 2 g every 4 hours). The route and dose should be selected according to the severity of infection and condition of patient. However, Intravenous route is the fastest route of drug action because more drug will be available in systemic circulation as soon as administration of the drug.

d. Meningitis cause inflammation. The edema due to the inflammation can damage the nervous and brain stem due to pressure which can leads to serious effects like seizures. Corticosteroids help to decrease inflammation and pressure on brain and spinal cord.

e. If the patient is allergic to penicillin, the patient has the chance to get allergic reactions with cephalosporins group of drugs. Thus a change in antibiotic to be considered. The common group of drug used to treat as an alternative to cephalosporins in bacterial meningitis is chloramphenicol. Vancomycin also can be used with combination to Chloramphenicol to reduce the risk of chloramphenicol failure.

f. The first line intravenous therapy for Methicillin-resistant Staphylococcus aureus is vancomycin, a Glycopeptide class of drug.Maximum of 2g can be given in divided doses.

g. The most common adverse effects of cefotaxime include local reaction on the injection site like pain and inflammation, hypersensitivity reactions like rash, pruritis, utricaria and fever. Gastrointestinal symptoms like colitis, diarrhea, nausea, and vomiting. Serious adverse reactions like arythmias, deranged liver enzymes,Neutropenia, transient leukopenia, eosinophilia, thrombocytopenia, encephalopathy are rare.