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Suspected Clinical Diagnosis (A) Meningitis, bacterial, communityacquired (B) Meningitis, bacterial, age > 50, community-acquired (C) Meningitis, postoperative (or posttraumatic) (D) Brain abscess Likely Etiologic Diagnosis Pneumococcus,1 meningococcus Pneumococcus, meningococcus, Listeria monocytogenes,3 gram-negative bacilli S aureus, gram-negative bacilli (pneumococcus, in posttraumatic) Mixed anaerobes, pneumococci, streptococci Pneumococci, M pneumoniae, Legionella, C pneumoniae S aureus, mixed anaerobes, gramnegative bacilli Drugs of Choice Cefotaxime,2 2 3 g IV every 6 hours; or ceftriaxone, 2 g IV every 12 hours plus vancomycin, 10 mg/kg IV every 8 hours Ampicillin, 2 g IV every 4 hours, plus cefotaxime or ceftriaxone and vancomycin as in (A) Vancomycin, 10 mg/kg IV every 8 hours, plus ceftazidime, 3 g IV every 8 hours Penicillin G, 4 million units IV every 4 hours, plus metronidazole, 500 mg orally every 8 hours; or cefotaxime or ceftriaxone as in (A) plus metronidazole, 500 mg orally every 8 hours Doxycycline, 100 mg IV or orally every 12 hours (or azithromycin), plus cefotaxime, 2 g IV every 8 hours (or ceftriaxone, 1 g IV every 24 hours); or a fluoroquinolone5 alone Cefepime, 2 g IV every 8 hours; or ceftazidime, 2 g IV every 8 hours; or piperacillin-tazobactam, 45 g IV every 6 hours; or imipenem, 500 mg IV every 6 hours; or meropenem, 1 g IV every 8 hours plus tobramycin, 5 mg/kg IV every 24 hours; or ciprofloxacin, 400 mg IV every 12 hours; or levofloxacin, 500 mg IV every 24 hours plus vancomycin, 15 mg/kg IV every 12 hours Vancomycin, 15 mg/kg IV every 12 hours, plus gentamicin, 1 mg/kg every 8 hours Vancomycin, 15 mg/kg IV every 12 hours plus ceftriaxone, 1 g IV every 24 hours Nafcillin, 2 g IV every 4 hours; or cefazolin, 2 g IV every 8 hours Ceftriaxone, 1 2 g IV every 24 hours Ceftriaxone, 1g IV every 24 hours; or ciprofloxacin, 400 mg IV every 12 hours (500 mg orally); or levofloxacin, 500 mg once daily (IV/PO) Ceftazidime, 2 g IV every 8 hours; or cefepime, 2 g IV every 8 hours Piperacillin-tazobactam as in (F) or ticarcillin-clavulanate, 31 g IV every 6 hours; or ertapenem, 1 g every 24 hours.

myOtherVariable = myVariable = 15;

(G) Endocarditis, acute (including injection drug user) (H) Septic thrombophlebitis (eg, IV tubing, IV shunts) (I) Osteomyelitis (J) Septic arthritis (K) Pyelonephritis with flank pain and fever (recurrent urinary tract infection) (L) Fever in neutropenic patient receiving cancer chemotherapy (M) Intra-abdominal sepsis (eg, postoperative, peritonitis, cholecystitis)

S aureus, E faecalis, gram-negative aerobic bacteria, viridans streptococci S aureus, gram-negative aerobic bacteria S aureus S aureus, N gonorrhoeae E coli, Klebsiella, Enterobacter, Pseudomonas S aureus, Pseudomonas, Klebsiella, E coli Gram-negative bacteria, Bacteroides, anaerobic bacteria, streptococci, clostridia

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Some strains may be resistant to penicillin Vancomycin can be used with or without rifampin Cefotaxime, ceftriaxone, ceftazidime, or ceftizoxime can be used Most studies on meningitis have been with cefotaxime or ceftriaxone (see text) 3 TMP-SMZ can be used to treat Listeria monocytogenes in patients allergic to penicillin in a dosage of 15 20 mg/kg of TMP in three or four divided doses 4 Depending on local drug susceptibility pattern, use tobramycin, 5 mg/kg/d, or amikacin, 15 mg/kg/d, in place of gentamicin 5 Levofloxacin, moxifloxacin

The preceding statement assigns 15 to myVariable, and then also assigns the value (15) to myOtherVariable. This works because the statement:

Erysipelas, impetigo, cellulitis, ascending lymphangitis Furuncle with surrounding cellulitis Pharyngitis

Phenoxymethyl penicillin, 05 g orally four times daily for 7 10 days Dicloxacillin, 05 g orally four times daily for 7 10 days Phenoxymethyl penicillin, 05 g orally four times daily for 10 days

Psychological strategies should include educating the patient regarding good sleep hygiene: (1) Go to bed only when sleepy (2) Use the bed and bedroom only for sleeping and sex (3) If still awake after 20 minutes, leave the bedroom and only return when sleepy (4) Get up at the same time every morning regardless of the amount of sleep during the night (5) Discontinue caffeine and nicotine, at least in the evening if not completely (6) Establish a daily exercise regimen (7) Avoid alcohol as it may disrupt continuity of sleep (8) Limit fluids in the evening (9) Learn and practice relaxation techniques A recent study suggests that cognitive behavioral therapy for insomnia was as effective as zolpidem with benefits sustained 1 year after treatment

myVariable = 15;

.

Figure C.3 The Mac OS memory model is primarily organized into a system partition, which holds system software and data structures, and application partitions, which hold application programs.

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