TY - CHAP M1 - Book, Section TI - Central Nervous System Infections A1 - Elshaboury, Ramy H. A1 - Ahiskali, Aileen S. A1 - Holt, Jessica S. A1 - Rotschafer, John C. A2 - DiPiro, Joseph T. A2 - Talbert, Robert L. A2 - Yee, Gary C. A2 - Matzke, Gary R. A2 - Wells, Barbara G. A2 - Posey, L. Michael PY - 2017 T2 - Pharmacotherapy: A Pathophysiologic Approach, 10e AB - Patient Care Process for CNS InfectionsCollectPatient characteristics (e.g., age, sex, weight, height, pregnancy status, allergies)Patient medical history (personal and family)Social history (e.g., ethanol/IV drug use, recent travel, home residence, exposure to animals) and dietary habits including intake of unpasteurized dairy productsCurrent medication use including anti-infective and immunomodulating agents.Vaccination history (e.g., PCV13, PPV23, Hib, MenACWY, MenB)Objective dataTemperature, blood pressure, respiratory rate, white blood cell count, lactate, procalcitonin, serum creatinine, blood urea nitrogenBlood/CSF examination, cultures, Gram stain, PCR, 16s rRNA, smear, AFB, serologyRadiologic imaging (MRI, CT)AssessPresence of risk factors (e.g., vaccination history, immunocompromised status, asplenia, recent dental procedure, endocarditis, consumption of unpasteurized dairy products, central venous catheter, CSF shunt)Signs and symptoms (e.g., temperature >100.4 F, nuchal rigidity, headache, Kernig and Bruzinski signs [Figs. 106-4 and 106-5], CSF characteristics [Table 106-1], radiographic evidence, pathogen identification)Local susceptibilities of suspected/proven pathogen(s)Source control of focal infection (e.g., minimally invasive aspiration of brain abscess)Barriers for successful completion of therapeutic regimenCandidates for chemoprophylaxisPlan*Evidence-based empiric drug therapy regimen including anti-infective agent(s) with good CNS penetration (Table 106-3), dose, route, frequency, and duration (see Tables 106-2 and 106-5, sections Health-Care Associated Ventriculitis and Meningitis, Bacterial Abscess, Viral Encephalitis, and CNS Infections in Special Populations)Definitive anti-infective therapy if specific pathogen identified (Tables 106-4 and 106-5, sections as above)Corticosteroid use when indicatedMonitoring parameters including efficacy (e.g., fever, mental status, meningismus, white blood cell count, radiologic resolution of focal infection, drug monitoring) and safety (e.g., renal function, drug-drug interactions); frequency and timing of follow-upPatient education (e.g., purpose of treatment, invasive procedures, drug-specific information)Referrals to other providers when appropriate (e.g., infectious diseases, neurologist, interventional radiologist)Implement*Provide patient education regarding all elements of treatment planEnsure effective transitions of careSchedule follow-up if treatment continues outpatient (e.g., SCr, adherence assessment, radiographic imaging)Follow-up: Monitor and EvaluateResolution of CNS infection symptoms (e.g., fever, nuchal rigidity, headache, altered mental status)Presence of adverse effects (e.g., acute renal injury, electrolyte abnormalities, QT interval prolongation)Patient adherence to treatment plan using multiple sources of informationDuration of therapy based on evidence-based guidelines, clinical and radiologic progress*Collaborate with patient, caregivers, and other health professionals SN - PB - McGraw-Hill Education CY - New York, NY Y2 - 2024/03/28 UR - accesspharmacy.mhmedical.com/content.aspx?aid=1154961444 ER -