Posttraumatic meningitis treatment [Neurosurgery Wiki]

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====== Posttraumatic meningitis treatment ======

see also [[Cerebrospinal fluid fistula treatment]].
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1. [[antibiotic]]s: appropriate antibiotics are selected based on [[CSF]] penetration and organism sensitivities (adapted to the pathogens common in the patient’s locale). For empiric antibiotics:
[[Vancomycin]] 15 mg/kg IV q 8–12 hours to achieve trough 15–20 mg/dl + [[meropenem]] 2 g IV q 8 hrs

3. [[pneumococcal vaccine]]: for adults (age ≥ 19 years) with [[Cerebrospinal fluid fistula]] who have not received any pneumococcal [[vaccine]]s, or for those with unknown vaccination history, the CDC recommends 1 dose of PCV13 and 1 or 2 doses of PPSV23 as follows
((CDC. Pneumococcal vaccine timing for adults. 2015. https://www.cdc.gov/vaccines/vpd/pneumo/downloads/pneumo-vaccine-timing.pdf))
(Note: these [[recommendation]]s are specific for adults with [[Cerebrospinal fluid fistula]]s and differ from general vaccination recommendations):

● 1 dose of pneumococcal conjugate vaccine (pneumococcal PCV13) (e.g. Prevnar 13)

● 1 dose of pneumococcal polysaccharide vaccine (PPSV23) (e.g. Pneumovax, Merck) at least 8 weeks later

● for patients ≥ 65 years: PPSV23 ≥ 8 weeks after PCV13 and ≥ 5 years after any PPSV23 at < 65 years

4. surgical treatment vs. “conservative treatment”: controversial. Some feel that any case of post-traumatic CSF rhinorrhea should be explored, and that cases of spontaneous cessation often represent obscuration by the incarcerated brain, so-called “sham healing” with the potential for later CSF leak and/or meningitis.

4 Others support the notion that cessation (possibly with the assistance of lumbar spinal drainage) is acceptable

5. continue antibiotics for 1 week after CSF is sterilized. If rhinorrhea persists at this time, surgical repair is recommended