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\author{Bailey\_Rickett}
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  /Title (pharmacology-of-encephalitis-bacterial-meningitis.pdf)
  /Creator (Cheatography)
  /Author (Bailey\_Rickett)
  /Subject (Pharmacology of Encephalitis/Bacterial Meningitis Cheat Sheet)
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    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Pharmacology of Encephalitis/Bacterial Meningitis Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{Bailey\_Rickett} via \textcolor{DarkBackground}{\uline{cheatography.com/184326/cs/38818/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}Bailey\_Rickett \\
  \uline{cheatography.com/bailey-rickett} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 19th May, 2023.\\
   Updated 19th May, 2023.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
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\begin{tabularx}{5.377cm}{x{1.29402 cm} x{3.68298 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Pathophysiology}}  \tn
% Row 0
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\seqsplit{Meningitis} & Inflection and inflammation of the meninges. \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\seqsplit{Encephalitis} & Infection and inflammation of the brain or spinal cord parenchyma itself. \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
Common causes: & Viruses, Bacteria, Fungi, and Parasites \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
 & Viral encephalitis is the most common type of encephalitis, but less severe than bacterial. \tn 
% Row Count 11 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{x{1.34379 cm} x{3.63321 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Encephalitis}}  \tn
% Row 0
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Common Viruses & {\bf{Herpes Simplex}} (most common, \textgreater{}42\%) \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & Varicella Zoster Virus \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Epstein Barr Virus \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
\seqsplit{Diagnostics} & Lumbar puncture- CSF \tn 
% Row Count 6 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & PCR for the identification of viruses (HSV, EBV, CMV,  HHV6, and enteroviruses) \tn 
% Row Count 9 (+ 3)
% Row 5
\SetRowColor{white}
 & *The same organisms responsible for viral meningitis usually are also responsible for encephalitis. \tn 
% Row Count 13 (+ 4)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Diagnostic Criteria for Encephalitis} \tn 
% Row Count 14 (+ 1)
% Row 7
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Major Criterion & Required \tn 
% Row Count 16 (+ 2)
% Row 8
\SetRowColor{LightBackground}
 & Subacute onset of impairment in the domains of consciousness, memory, mental status, or new onset psychiatric changes without alternative cause. \tn 
% Row Count 21 (+ 5)
% Row 9
\SetRowColor{white}
Minor Criterion & ( at least 2) \tn 
% Row Count 23 (+ 2)
% Row 10
\SetRowColor{LightBackground}
 & Fever \textgreater{}/= 100.4 F within the 72 hours before or after presentation \tn 
% Row Count 26 (+ 3)
% Row 11
\SetRowColor{white}
 & Seizures not attributed to a previous seizure disorder. \tn 
% Row Count 28 (+ 2)
% Row 12
\SetRowColor{LightBackground}
 & Cerebrospinal fluid pleocytosis (WBC \textgreater{} 5/cubic mm) \tn 
% Row Count 30 (+ 2)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Encephalitis (cont)}}  \tn
% Row 13
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 & Evidence of brain parenchymal inflammation on neuroimaging (acute or subacute) \tn 
% Row Count 3 (+ 3)
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\begin{tabularx}{5.377cm}{x{1.29402 cm} x{3.68298 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Symptoms of Meningitis}}  \tn
% Row 0
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Early Symptoms & Headache \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & Fever \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
 & Nausea \tn 
% Row Count 4 (+ 1)
% Row 3
\SetRowColor{white}
 & Vomiting \tn 
% Row Count 5 (+ 1)
% Row 4
\SetRowColor{LightBackground}
Later Symptoms & Drowsiness \tn 
% Row Count 7 (+ 2)
% Row 5
\SetRowColor{white}
 & Confusion \tn 
% Row Count 8 (+ 1)
% Row 6
\SetRowColor{LightBackground}
 & Stiff ness and pain on flexion of the neck (Nuchal Rigidity) \tn 
% Row Count 11 (+ 3)
% Row 7
\SetRowColor{white}
 & Seizures \tn 
% Row Count 12 (+ 1)
% Row 8
\SetRowColor{LightBackground}
 & Non-blanching purpuric rash (Meningococcal) \tn 
% Row Count 14 (+ 2)
% Row 9
\SetRowColor{white}
 & Photophobia \tn 
% Row Count 15 (+ 1)
% Row 10
\SetRowColor{LightBackground}
 & Rapid Breathing Rate \tn 
% Row Count 16 (+ 1)
% Row 11
\SetRowColor{white}
Triad & Headache \tn 
% Row Count 17 (+ 1)
% Row 12
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 & Fever \tn 
% Row Count 18 (+ 1)
% Row 13
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 & Nuchal Rigidity \tn 
% Row Count 19 (+ 1)
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Meningococcal Meningitis}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the thin lining that surrounds the brain and spinal cord.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{This is the most important pathogen for meningitis (Neisseria Meningitides) because it has the potential to cause epidemics.} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Characterized by non-blanching purpura.} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{You can easily tell it by pushing a glass against it and if it disappears it is not meningitis.} \tn 
% Row Count 9 (+ 2)
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Meningococcal Meningitis}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{Meningococcal meningitis is a bacterial form of meningitis, a serious infection of the thin lining that surrounds the brain and spinal cord.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{This is the most important pathogen for meningitis (Neisseria Meningitides) because it has the potential to cause epidemics.} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Characterized by non-blanching purpura.} \tn 
% Row Count 7 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{You can easily tell it by pushing a glass against it and if it disappears it is not meningitis.} \tn 
% Row Count 9 (+ 2)
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Types of Antibiotics vs. Age}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1684516642_IMG_2312.jpeg}}} \tn 
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\begin{tabularx}{5.377cm}{x{1.94103 cm} x{3.03597 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Is Meningitis Contagious?}}  \tn
% Row 0
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Parasitic & non contagious \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Fungal & non contagious \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Viral & contagious \tn 
% Row Count 3 (+ 1)
% Row 3
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Bacterial & contagious \tn 
% Row Count 4 (+ 1)
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{General Notes on CNS Infections}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Acute infections such as bacterial and viral meningitis and encephalitis require quick distinguishing and treatment.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{It is imperative to differentiate between them, identify the pathogen, and quickly initiate therapy.} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Neisseria, Haemophilus, Hepes simplex 1, Varicella Zoster} \tn 
% Row Count 7 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Symptoms of Encephalitis}}  \tn
% Row 0
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\mymulticolumn{1}{x{5.377cm}}{Deep cognitive functions disturbed.} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Confusion or disorientation.} \tn 
% Row Count 2 (+ 1)
% Row 2
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\mymulticolumn{1}{x{5.377cm}}{Seizures or fits.} \tn 
% Row Count 3 (+ 1)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Changes in personality and behavior.} \tn 
% Row Count 4 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Difficulty speaking.} \tn 
% Row Count 5 (+ 1)
% Row 5
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Weakness or loss of movement in some parts of the body.} \tn 
% Row Count 7 (+ 2)
% Row 6
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Loss of consciousness.} \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Diagnostics to Confirm Meningitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{CT- to rule out bleeds} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Head Scans} \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Lumbar Puncture (Gold Standard) confirms diagnosis. This is CI in meningococcal septicemia, so you need to do blood cultures and PCR, instead. CI if there is bulging of the fontanells in an infant (this indicates increased ICP), CI in hydrocephalus.} \tn 
% Row Count 7 (+ 5)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{PCR- determines viral etiology} \tn 
% Row Count 8 (+ 1)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Blood Culture} \tn 
% Row Count 9 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Empiric Treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
Preterm to \textless{}1 Month old & \seqsplit{Ampicillin+Cefotaxime} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
1-3 Months old & Ampicillin+ Cefotaxime or Ceftriaxone \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\textgreater{}3 months to adults \textless{}50 & Ceftriaxone or Cefotaxime+ Vancomycin+ Dexamethasone (steroid for ICP) \tn 
% Row Count 8 (+ 4)
% Row 3
\SetRowColor{white}
Adults with \textgreater{}55 or with alcoholism or disease & worried about listeria so + ampicillin (Ampicillin +Ceftriaxone or Cefotaxime + Vancomycin + Dexamethasone) \tn 
% Row Count 14 (+ 6)
% Row 4
\SetRowColor{LightBackground}
Alternatives for penicillin allergy & Can substitute TMP-SMP (Bactrim) or meropenem for Ampicillin if you need the possible listeria coverage in immunosuppressed or \textgreater{}50 yo \tn 
% Row Count 21 (+ 7)
% Row 5
\SetRowColor{white}
 & Meropenem can also be substituted in for ceph if can't take ceph. Aztreonam is also an option. \tn 
% Row Count 26 (+ 5)
% Row 6
\SetRowColor{LightBackground}
Dexamethasone & Given 10-20 minutes before antibiotic therapy and continue for 2-4 days \tn 
% Row Count 30 (+ 4)
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\begin{tabularx}{5.377cm}{x{2.4885 cm} x{2.4885 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Empiric Treatment (cont)}}  \tn
% Row 7
\SetRowColor{LightBackground}
 & Shown to decrease morbidity and mortality by decrease inflammatory response secondary to bacterial lysis which usually causes detrimental physiologic effects- used for s. pneumo or haemophilus causes only, not shown to benefit with other pathogens. \tn 
% Row Count 13 (+ 13)
% Row 8
\SetRowColor{white}
 & No benefit if given after antibiotics are initiated. \tn 
% Row Count 16 (+ 3)
% Row 9
\SetRowColor{LightBackground}
 & Given IV 10mg (0.15 mg/kg ped) Q6hrs for up to 4 days \tn 
% Row Count 19 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Bacterial Meningitis Treatment}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{If the lumbar puncture is  delayed for any reason, including the need for additional diagnostic testing, such as a CT scan of the head- then empiric antibiotic therapy should be started as soon as possible, ideally after blood cultures have been performed.} \tn 
% Row Count 6 (+ 6)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{It is important to start antibiotic therapy even if the evaluation for bacterial meningitis is ongoing, since as delay in treatment is associated with increased morbidity and mortality. Recommended empiric treatment of bacterial meningitis is based on a patient's age and comorbid conditions.} \tn 
% Row Count 12 (+ 6)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{x{1.24425 cm} x{3.73275 cm} }
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Vancomycin}}  \tn
% Row 0
\SetRowColor{LightBackground}
MOA: & Inhibits peptidoglycan cross linking, leading to weaker cell membrane \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\seqsplit{Indications:} & Primarily activity is against {\bf{gram positive}} (too large to penetrate through gram negative cell membranes) \tn 
% Row Count 7 (+ 4)
% Row 2
\SetRowColor{LightBackground}
\seqsplit{Formulations:} & Administered via IV infusion (oral is only given for the treatment of colitis caused by cdiff) \tn 
% Row Count 11 (+ 4)
% Row 3
\SetRowColor{white}
ADRs & Fairly frequent. Irritating to tissues, chills, fever, {\bf{nephrotoxicity}} is common, rare {\bf{ototoxicity}} {\bf{red man syndrome}} (infusion flushing caused by the release of histamine can prevent this by administering slowly, or pretreating with antihistamines ) \tn 
% Row Count 20 (+ 9)
% Row 4
\SetRowColor{LightBackground}
Notes & Widely distributed into tissues, including adipose, but poorly absorbed from GI tract \tn 
% Row Count 23 (+ 3)
% Row 5
\SetRowColor{white}
 & Therapeutic drug monitoring protocols of vancomycin are put in place to measure AUC levels in order to minimize occurrence of nephrotoxicity. Calculating AUC is used to check for therapeutic levels and to monitor for toxicity. Accumulates in renal therapy. \tn 
% Row Count 32 (+ 9)
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\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Vancomycin (cont)}}  \tn
% Row 6
\SetRowColor{LightBackground}
 & Treats MRSA \tn 
% Row Count 1 (+ 1)
% Row 7
\SetRowColor{white}
 & Works synergistically with gentamicin and other aminoglycosides for treating enterococci. \tn 
% Row Count 4 (+ 3)
% Row 8
\SetRowColor{LightBackground}
 & VRE (vancomycin resistant enterococci) are becoming more prevalent. \tn 
% Row Count 7 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Meningitis vs. Encephalitis}}  \tn
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\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1684512541_IMG_2310.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{X}
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\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Treatment of Encephalitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Start {\bf{IV Acyclovir}} (for herpes simplex) while awaiting CSF results. This is the empiric therapy of choice.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Herpes Simplex is the {\bf{most common}} cause of encephalitis so starting acyclovir will help to prevent death or serious outcomes.} \tn 
% Row Count 6 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{{\bf{Pediatrics and Adults}}: acyclovir 10mg/kg IV q8h} \tn 
% Row Count 8 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Acyclovir is used to prevent and treat herpes infection of the skin, mouth, and mucous membranes; herpes zoster (shingles); chicken pox; and genital herpes.} \tn 
% Row Count 12 (+ 4)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{5.377cm}{x{2.83689 cm} x{2.14011 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{CFS Analysis}}  \tn
% Row 0
\SetRowColor{LightBackground}
Bacterial & Viral \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
Cloudy & Clear (Usually) \tn 
% Row Count 2 (+ 1)
% Row 2
\SetRowColor{LightBackground}
Glucose is low (bacteria is using the glucose) & 60-80\% of normal plasma levels \tn 
% Row Count 5 (+ 3)
% Row 3
\SetRowColor{white}
Proteins are high & Normal protein levels \tn 
% Row Count 7 (+ 2)
% Row 4
\SetRowColor{LightBackground}
WBC- Neutrophils, PMNs & Lymphocytes \tn 
% Row Count 8 (+ 1)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{0.96071 cm} x{0.96071 cm} x{0.96071 cm} x{1.29487 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{4}{x{5.377cm}}{\bf\textcolor{white}{Bacterial Meningitis Causes}}  \tn
% Row 0
\SetRowColor{LightBackground}
0-6mos & \seqsplit{6mos-6yrs} & \seqsplit{6yrs-60yrs} & 60+ \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
Group B Strep & S. \seqsplit{Pneumoniae} & S. \seqsplit{Pneumoniae} & S. Peneumoniae \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
E. Coli & N. \seqsplit{Meningitis} & N. \seqsplit{Meningitis} & Gram Negative Rods \tn 
% Row Count 6 (+ 2)
% Row 3
\SetRowColor{white}
Listeria & \seqsplit{Enterovirus} & HSV-1 & Listeria \tn 
% Row Count 8 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & H. \seqsplit{Influenza} & \seqsplit{Enterovirus} &  \tn 
% Row Count 10 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}----}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Causes Notes}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Usually caused by strep pneumoniae and Neisseria meningitis in those 2-50 yo} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Listeria monocytogenes should be considered in pregnancy, \textgreater{}50, alcoholics, and immunocompromised patients.} \tn 
% Row Count 5 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Bacteria Meningitis Causes and Treatments}}  \tn
\SetRowColor{LightBackground}
\mymulticolumn{1}{p{5.377cm}}{\vspace{1px}\centerline{\includegraphics[width=5.1cm]{/web/www.cheatography.com/public/uploads/bailey-rickett_1684514703_IMG_2311.jpeg}}} \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{5.377cm}}{\bf\textcolor{white}{Medications and the CSF}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{The CSF is hard for a lot of medications to penetrate due to the BBB. To overcome this you can increase the dose or depend on the inflammation to open up permeability.} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Most medications do not penetrate into the uninflamed meninges, however in meningitis a lot of antibiotics are able to gain higher concentrations in the CSF because the inflammatory response allows the BBB to be more penetrable to hydrophilic substances (we already know lipophilic drugs have are more permeable)} \tn 
% Row Count 11 (+ 7)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Ex. Hydrophilic antibiotics are beta lactams and vancomycin.} \tn 
% Row Count 13 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{5.377cm}}{Beta lactams have the most evidence behind them in meningitis prophylaxis due to their ability to eradicate the causative pathogens, BUT dosing has to be {\bf{increased}} in order to gain appropriate concentrations in the CSF.} \tn 
% Row Count 18 (+ 5)
% Row 4
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{5.377cm}}{Of the cephalosporins cefotaxime and ceftriaxone are the most used.} \tn 
% Row Count 20 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
\end{tabularx}
\par\addvspace{1.3em}

\begin{tabularx}{5.377cm}{x{1.84149 cm} x{3.13551 cm} }
\SetRowColor{DarkBackground}
\mymulticolumn{2}{x{5.377cm}}{\bf\textcolor{white}{Prophylaxis for Meningitis}}  \tn
% Row 0
\SetRowColor{LightBackground}
Haemophilus Influenza B & Rifampin for 4 days for both peds and adults \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
 & recommended for all household contacts with kids \textless{}4 that haven't been fully vaccinated, child care settings when 2 or more chases have occurred within 60 days. \tn 
% Row Count 9 (+ 7)
% Row 2
\SetRowColor{LightBackground}
Neisseria Meningitidis & Rifampin (2 days) \tn 
% Row Count 11 (+ 2)
% Row 3
\SetRowColor{white}
 & Ciprofloxacin (adults only) (BS) \tn 
% Row Count 13 (+ 2)
% Row 4
\SetRowColor{LightBackground}
 & Ceftriaxone (IM 1 dose) \tn 
% Row Count 14 (+ 1)
% Row 5
\SetRowColor{white}
 & start withing 24 hours after identified, should involve household members, child care contacts, direct exposure to oral secretions. After 14 days no prophylaxis is recommended. \tn 
% Row Count 22 (+ 8)
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\SetRowColor{LightBackground}
\mymulticolumn{2}{x{5.377cm}}{Report all cases to the CDC}  \tn 
\hhline{>{\arrayrulecolor{DarkBackground}}--}
\end{tabularx}
\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}