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22. Tunkel A, Hartman B et al. Practice Guidelines for the Management of Bacterial Meningitis. Clinical Infectious Diseases 2004;39:1267-1284 / IDSA Guidelines.
23. Tunkel A, Hartman B et al. Practice Guidelines for the Management of Bacterial Meningitis. Clinical Infectious Diseases 2004;39:1267-1284 / IDSA Guidelines. Vancomycin plus cefepime, c vancomycin plus ceftazidime, c or vancomycin plus meropenem Coagulase-negative staphylococci (especially S. epidermidis), S. aureus, aerobic gram-negative bacilli (including P. aeruginosa), Propionibacterium acnes CSF shunt Vancomycin plus cefepime, vancomycin plus ceftazidime, or vancomycin plus meropenem Aerobic gram-negative bacilli (including P. aeruginosa), S . aureus , coagulase-negative staphylococci (especially S. epidermidis) Postneurosurgery Vancomycin plus cefepime, vancomycin plus ceftazidime, or vancomycin plus meropenem Staphylococcus aureus, coagulase-negative staphylococci (especially Staphylococcus epidermidis), aerobic gram-negative bacilli (including Pseudomonas aeruginosa) Penetrating trauma Vancomycin plus a third-generation cephalosporin a S. pneumoniae, H. influenzae, group A β -hemolytic streptococci Basilar skull fracture Head trauma Vancomycin plus ampicillin plus a third-generation cephalosporin a, b S. pneumoniae, N. meningitidis, L. monocytogenes, aerobic gram-negative bacilli >50 years Vancomycin plus a third-generation cephalosporin a, b N . meningitidis, S. pneumoniae 2 - 50 years Vancomycin plus a third-generation cephalosporin a, b Streptococcus pneumoniae, Neisseria meningitidis, S. agalactiae, Haemophilus influenzae, E. coli 1 - 23 months Ampicillin plus cefotaxime or ampicillin plus an aminoglycoside Streptococcus agalactiae, Escherichia coli, Listeria monocytogenes, Klebsiella species <1 month Age Antimicrobial therapy Common bacterial pathogens Predisposing factor
24. Duración de la terapia Tunkel A, Hartman B et al. Practice Guidelines for the Management of Bacterial Meningitis. Clinical Infectious Diseases 2004;39:1267-1284 / IDSA Guidelines. 21 Listeria monocytogenes 21 Aerobic gram-negative bacilli 14 - 21 Streptococcus agalactiae 10 - 14 Streptococcus pneumoniae 7 Haemophilus influenzae 7 Neisseria meningitidis Duration of therapy, days Microorganism
28. Criterios para continuar manejo ambulatorio Tunkel A, Hartman B et al. Practice Guidelines for the Management of Bacterial Meningitis. Clinical Infectious Diseases 2004;39:1267-1284 / IDSA Guidelines. Safe environment with access to a telephone, utilities, food, and refrigerator Patient and/or family compliance with the program Established plan for physician visits, nurse visits, laboratory monitoring, and emergencies Daily availability of a physician Reliable intravenous line and infusion device (if needed) Access to home health nursing for antimicrobial administration Ability to take fluids by mouth Clinical stability or improving condition No significant neurologic dysfunction, focal findings, or seizure activity Absence of fever for at least 24 48 h prior to initiation of outpatient therapy Inpatient antimicrobial therapy for 6 days