Yes, cerebrospinal fluid (CSF) lactate can be a reliable marker to monitor the response to treatment in bacterial meningitis and may even be superior to CSF glucose in certain scenarios.: as glu has limitations in dm/ sampling etc, slow response Advantages of CSF Lactate: Marker of Infection Severity: Elevated CSF lactate (>4 mmol/L) strongly suggests bacterial meningitis. It is less influenced by systemic factors like blood glucose levels compared to CSF glucose. Lactate increases in response to bacterial metabolism, local tissue hypoxia, and inflammation, making it a sensitive marker for bacterial infection. Faster Normalization: CSF lactate tends to normalize within 2-4 days of effective antibiotic treatment, reflecting rapid control of infection. This provides a clearer and more immediate indication of therapeutic success compared to CSF glucose. Utility in Special Populations: In conditions where CSF glucose interpretation may be challenging (e.g., diabetics or individuals with impaired glucose metabolism), CSF lactate offers a more reliable alternative. HOWEVER DX SHOULD BE CLEAR OF ABM AS CSF LACTATE CAN RISE BCZ OF OTHER REASONS AND ALL LABS DO NOT MEASURE IT
@youngindiaintensivist7709 thank you so much sir for your time Also in case of surgical meningitis where cellularity and protein etc may change due to disruptive effects of surgery ..lactate can have better specificity..
@@youngindiaintensivist7709 But in other comment you said that since mdr is rampant now in India, even community infections are very commonly coming out as mdr?
@@ipathak7 it depends upon what your antibiogram of opd /ward pts is -- community resistance is variable. PL UNDERSTAND ONE HAS TO KNOW THE C/S PATTERNS OF PTS COMING TO YOUR ICU AND THOSE TO OPD , THAT DETERMINES YOUR ANTIBIOTIC USEAGE , THERE IS INCREASING RESISTANCE BUT IN CERTAI AREAS THEY ARESTILL EFFECTIVE ---THIS IS PRINCIPLE OF ANTIBIOTIC USE
amg are not good for pneumonia- poor penetration, in tb they are second line only and in tb bacterial load is generally less, for cns tb yes stm is 1st line, though no guidelines recommend neb abs, amg do reach good levels with neb in lungs as per some evidence. hence can try neb amg in pneumonia
How an antibiotic works has no universal answer. It varies across ICUs depending on what is the antibiogram of ur Icu. If your antibiogram is showing sensitivity to the drug even pip taz will work So please look at the antibiogram for community infections and nisocomial infn in ur hospital What combination works for ur icu may not work fr my ICU All in all this will be good for Community acwuired but cef Avi would be better for nosocomial infn as studies have shown cef avi is superior to colistin even when there is sensitivity and nosocomial is likely to be resistant to mero
So there already lots of webinars done on infections and antibiotics. Please see playlist of infections Colistin dose in n gfr is 9 MU stat and 4.5MU q12h 12MU is also given as loading if pts weight is more If gfr
@ranjith -- MDR Is found in community as well now ,in fact there is 20-30% prevalance of cre in community in india . If u recall classical teaching for starting antibiotics in icu for community admissions was u should assess for risk factors for mdr and these were - treatment with abs recently, hospital stay, on mhd,etc. However now one gives antibiotics for community infection as per the antibiogram for these pts coming to icu because there is variation from region to region in prevalence of mdr in community as there is widespread mdr in hospitals this has spread to community. one decade ago there was lmtd mdr in community, now its widespread in india
what antibiotic u give depends on the antibiogram of ur icu . If ur gnb are susceptible u can give mero +amg as empiric rx. Metrogyl is not needed with mero.
The only absolute contra is neuromuscular disease . Can be used in Pregnancy if no better option. Similarly in renal failure modified dose can be given
dr roshan loading dose of all antibiotics remains unchanged, so u wl give 400 12 hrly 3 doses then 200 od. however higher dose is also used for sick pts ie 800 loading 3 doses then 400 od in ckd
Excellent. Thanx
Very important tips for antibiotics
Great info Sir
glad u liked it
As soon as i see a complicated culture sensitivity report, my mind goes blank. How do i go about a c/s report which shows pan-resistance
@anwar,, Kindly search in our channel & go through the video on c/s
Sir instead of following CSF sugars and it's downside in hospital acquired meningitis ...can following CSF lactate be better??
Yes, cerebrospinal fluid (CSF) lactate can be a reliable marker to monitor the response to treatment in bacterial meningitis and may even be superior to CSF glucose in certain scenarios.:
as glu has limitations in dm/ sampling etc, slow response
Advantages of CSF Lactate:
Marker of Infection Severity:
Elevated CSF lactate (>4 mmol/L) strongly suggests bacterial meningitis. It is less influenced by systemic factors like blood glucose levels compared to CSF glucose.
Lactate increases in response to bacterial metabolism, local tissue hypoxia, and inflammation, making it a sensitive marker for bacterial infection.
Faster Normalization:
CSF lactate tends to normalize within 2-4 days of effective antibiotic treatment, reflecting rapid control of infection.
This provides a clearer and more immediate indication of therapeutic success compared to CSF glucose.
Utility in Special Populations:
In conditions where CSF glucose interpretation may be challenging (e.g., diabetics or individuals with impaired glucose metabolism), CSF lactate offers a more reliable alternative.
HOWEVER DX SHOULD BE CLEAR OF ABM AS CSF LACTATE CAN RISE BCZ OF OTHER REASONS AND ALL LABS DO NOT MEASURE IT
@youngindiaintensivist7709 thank you so much sir for your time
Also in case of surgical meningitis where cellularity and protein etc may change due to disruptive effects of surgery ..lactate can have better specificity..
Sir then which oral antibiotic should be given ico uncomplicated uti? Cotri?
ipathak
Fosfo satchets every 3 days for 2 doses ,cotri,levo are good
@ but in the video only you said fq resistant is so high that its almost useless?
@ipathak7 uncomplicated UTI is a term we use for non ICU pt generally. In ICU pt there would be resistance
@@youngindiaintensivist7709 But in other comment you said that since mdr is rampant now in India, even community infections are very commonly coming out as mdr?
@@ipathak7 it depends upon what your antibiogram of opd /ward pts is -- community resistance is variable. PL UNDERSTAND ONE HAS TO KNOW THE C/S PATTERNS OF PTS COMING TO YOUR ICU AND THOSE TO OPD , THAT DETERMINES YOUR ANTIBIOTIC USEAGE , THERE IS INCREASING RESISTANCE BUT IN CERTAI AREAS THEY ARESTILL EFFECTIVE ---THIS IS PRINCIPLE OF ANTIBIOTIC USE
aminoglycosides have very good penetration in lung (hence used in MDR/XDR TB), but poor penetration in pleural space.
amg are not good for pneumonia- poor penetration, in tb they are second line only and in tb bacterial load is generally less, for cns tb yes stm is 1st line, though no guidelines recommend neb abs, amg do reach good levels with neb in lungs as per some evidence. hence can try neb amg in pneumonia
Some infections disease specialist advice polymyxin-b with meropenem combination as supercombination,how does it work?
How an antibiotic works has no universal answer. It varies across ICUs depending on what is the antibiogram of ur Icu. If your antibiogram is showing sensitivity to the drug even pip taz will work
So please look at the antibiogram for community infections and nisocomial infn in ur hospital
What combination works for ur icu may not work fr my ICU
All in all this will be good for Community acwuired but cef Avi would be better for nosocomial infn as studies have shown cef avi is superior to colistin even when there is sensitivity and nosocomial is likely to be resistant to mero
sir please arrange more classes on different infections and what is colistin dose sir
So there already lots of webinars done on infections and antibiotics. Please see playlist of infections
Colistin dose in n gfr is 9 MU stat and 4.5MU q12h
12MU is also given as loading if pts weight is more
If gfr
Sir why is mdr organism found only in hosp and not from community acquired infection??
@ranjith -- MDR Is found in community as well now ,in fact there is 20-30% prevalance of cre in community in india . If u recall classical teaching for starting antibiotics in icu for community admissions was u should assess for risk factors for mdr and these were - treatment with abs recently, hospital stay, on mhd,etc. However now one gives antibiotics for community infection as per the antibiogram for these pts coming to icu because there is variation from region to region in prevalence of mdr in community as there is widespread mdr in hospitals this has spread to community. one decade ago there was lmtd mdr in community, now its widespread in india
If patient has septic shock -Why to give Ceftazidime avi at onset ??Can't we give Carbapenem+aminoglycoside+metro ??
what antibiotic u give depends on the antibiogram of ur icu . If ur gnb are susceptible u can give mero +amg as empiric rx. Metrogyl is not needed with mero.
Ok
What is role of double anerobic coverage in intraabdominal infection like piptaz vs piptaz + metro
pip taz is a weak drug for anaerobic infection. hence need to give metrogyl for iai
@@youngindiaintensivist7709 but sir surgical society infection guidelines do not recommend for double coverage with piptz mero imi and moxy
Contra. For aminoglycosides. Is it pregnancy¿mitochondrial disease¿😅
The only absolute contra is neuromuscular disease . Can be used in Pregnancy if no better option. Similarly in renal failure modified dose can be given
Sir wat is loading dose of tiecoplanin in ckd,is it 400mg bd*3dose?and maintance dose?
dr roshan loading dose of all antibiotics remains unchanged, so u wl give 400 12 hrly 3 doses then 200 od. however higher dose is also used for sick pts ie 800 loading 3 doses then 400 od in ckd
@@youngindiaintensivist7709 thanks sir