Pediatric Aseptic Meningitis Medication

Updated: Mar 05, 2015
  • Author: Saul N Faust, MBBS, PhD, MA, MRCPCH(UK); Chief Editor: Russell W Steele, MD  more...
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Medication

Medication Summary

Drug therapy is currently not a component of the standard of care for pediatric aseptic meningitis. Follow standard local analgesic regimens.

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Antibiotics

Class Summary

Ceftriaxone, cefotaxime, and vancomycin should be considered if bacterial meningitis cannot be excluded.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with broad-spectrum gram-negative activity; it has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms. It arrests bacterial growth by binding to 1 or more penicillin-binding proteins (PBPs).

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin with a gram-negative spectrum; it has lower efficacy against gram-positive organisms. It arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth.

Vancomycin

Vancomycin is a potent antibiotic directed against gram-positive organisms and active against Enterococcus species. It is indicated for patients who cannot receive or have failed to respond to penicillins and cephalosporins or who have infections caused by resistant staphylococci. For abdominal penetrating injuries, it is combined with an agent active against enteric flora, anaerobes, or both.

To prevent toxicity, the current recommendation is to assay vancomycin trough levels after the third dose, 30 minutes before the next dose. Use the creatinine clearance to adjust dosing in patients diagnosed with renal impairment.

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Antiviral Agents

Class Summary

Antiviral agents inhibit viral replication and activity. Antiviral medications should be considered if viral encephalitis cannot be excluded.

Acyclovir (Zovirax)

Acyclovir is a prodrug activated through phosphorylation by a virus-specific thymidine kinase (TK) that inhibits viral replication. Herpesvirus TK (but not host cell TK) uses acyclovir as a purine nucleoside, converting it into acyclovir monophosphate, a nucleotide analogue. Guanylate kinase converts the monophosphate form into diphosphate and triphosphate analogues that inhibit viral DNA replication. Acyclovir inhibits the activity of both herpes simplex virus (HSV)–1 and HSV-2.

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Antitubercular Agents

Class Summary

If tuberculous meningitis is suspected or proved, administer specific antimicrobial therapy and intravenous corticosteroids. In pediatric patients older than 3 months, the use of steroids is recommended for bacterial meningitis. [50] (See Pediatric Bacterial Meningitis.) Steroids are not recommended for use in aseptic meningitis.

The goals of tuberculosis (TB) treatment are to shorten the clinical course of TB, prevent complications, prevent the development of latency and/or subsequent recurrences, and decrease the likelihood of TB transmission. Antituberculous medications should be considered if tuberculous meningitis cannot be excluded.

Isoniazid

This is the drug of choice for preventive therapy and the primary drug in combination therapy for active TB. In patients receiving treatment for active TB, pyridoxine 25-50 mg PO qd should be coadministered to prevent peripheral neuropathy.

Rifampin (Rifadin)

Rifampin is used in combination with at least 1 other antituberculous drug. It inhibits DNA-dependent bacterial, but not mammalian, RNA polymerase. Cross-resistance may occur.

In most susceptible cases, the patient undergoes 6 months of treatment. Treatment lasts for 9 months if the patient's sputum culture result is still positive after 2 months of therapy.

Pyrazinamide

This is a pyrazine analog of nicotinamide that is either bacteriostatic or bactericidal against M tuberculosis, depending on the concentration of drug attained at the site of infection. Pyrazinamide's mechanism of action is unknown.

Administer the drug for the initial 2 months of a 6-month or longer treatment regimen for drug-susceptible TB. Treat drug-resistant TB with individualized regimens.

Ethambutol (Myambutol)

Ethambutol diffuses into actively growing mycobacterial cells (eg, tubercle bacilli). It impairs cell metabolism by inhibiting the synthesis of 1 or more metabolites, which, in turn, causes cell death. No cross-resistance has been demonstrated.

Mycobacterial resistance is frequent with previous therapy. In such cases, use ethambutol in combination with second-line drugs that have not been previously administered. Administer q24h until permanent bacteriologic conversion and maximal clinical improvement are observed. Absorption is not significantly altered by food.

Streptomycin

Streptomycin sulfate is used for the treatment of susceptible mycobacterial infections. Use this agent in combination with other antituberculous drugs (eg, isoniazid, ethambutol, rifampin). The total period of treatment for TB is a minimum of 6 months. However, streptomycin therapy is not commonly used for the duration of therapy. The drug is recommended when less potentially hazardous therapeutic agents are ineffective or contraindicated.

Rifapentine (Priftin)

This agent is used in once-weekly regimens along with isoniazid. Rifapentine should not be used in individuals with HIV infection or with positive cultures after 2 months of treatment.

Ethionamide (Trecator)

Ethionamide is a second-line drug that is bacteriostatic against M tuberculosis. It is recommended if treatment with first-line drugs (isoniazid, rifampin) is unsuccessful. Ethionamide can be used to treat any form of active TB. However, it should be used only with other effective antituberculous agents.

Cycloserine (Seromycin)

Cycloserine, a second-line drug, inhibits cell wall synthesis in susceptible strains of gram-positive and gram-negative bacteria and in M tuberculosis. It is a structural analogue of D-alanine, which antagonizes the role of D-alanine in bacterial cell wall synthesis, inhibiting growth.

Capreomycin (Capastat)

Capreomycin is a second-line drug obtained from Streptomyces capreolus for coadministration with other antituberculous agents in pulmonary infections caused by capreomycin-susceptible strains of M tuberculosis. Capreomycin is used only when first-line agents (eg, isoniazid, rifampin) have been ineffective or cannot be used because of toxicity or the presence of resistant tubercle bacilli.

Rifabutin (Mycobutin)

This is an ansamycin antibiotic derived from rifamycin S. Rifabutin inhibits DNA-dependent RNA polymerase, preventing chain initiation. It is used for TB treatment in individuals on specific HIV medications, when rifampin is contraindicated (most protease inhibitors).

Dapsone

Dapsone is bactericidal and bacteriostatic against Mycobacterium strains. Its mechanism of action is similar to that of sulfonamides, in which competitive antagonists of PABA prevent the formation of folic acid, causing bacterial growth inhibition. The use of dapsone in the treatment of TB is largely experimental.

Aminosalicylic Acid (Paser)

This is a bacteriostatic agent that is useful against M tuberculosis. It inhibits the onset of bacterial resistance to streptomycin and isoniazid. Administer aminosalicylate sodium with other antituberculous drugs.

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