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Pseudomonas Meningitis CNS Antibiotics — SCE Infectious Diseases MCQ

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HardCNS InfectionPseudomonas Meningitis CNS AntibioticsSCE Infectious Diseases

A 50-year-old man develops Gram-negative meningitis following trans-sphenoidal pituitary surgery. CSF culture grows Pseudomonas aeruginosa. What IV antibiotic achieves the best CNS penetration for Pseudomonas meningitis?

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Correct answer: A — IV Meropenem 2 g TDS (at meningitis dosing

Post-neurosurgical Pseudomonas meningitis requires antibiotics with both anti-pseudomonal activity AND adequate CSF penetration. Meropenem at meningitis dose (2 g TDS — higher than standard 1 g TDS) achieves adequate CSF levels (10–20% of serum levels with inflamed meninges). Ceftazidime (2 g TDS) is an alternative. Aminoglycosides (Gentamicin, Amikacin) have poor CSF penetration — intrathecal/intraventricular administration may be needed for refractory cases. Ciprofloxacin has variable CNS penetration and is not first-line for meningitis. Duration: at least 21 days for Gram-negative meningitis.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/infections