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sistance in the physician s local area, especially in the case of pneumococcal infections Throughout the course of treatment, it is necessary to have access to a dependable laboratory that can carry out rapid and detailed drug-resistance testing In cases of meningitis due to Staph aureus, including those that occur after neurosurgery or major head injury, administration of vancomycin and cefepime is a reasonable rst approach, the cefepime offering better activity against Staph aureus than does ceftazidime (both are poor for methicillin-resistant organisms) Once the sensitivity of the organism has been determined, therapy may have to be altered or may be simpli ed by using vancomycin or nafcillin alone The recommended dosages of the major antibiotics are listed in Table 32-3, and the choice of antibiotic for the optimal treatment of speci c bacterial isolates is given in Table 32-4 Duration of Therapy Most cases of bacterial meningitis should be treated for a period of 10 to 14 days except when there is a persistent parameningeal focus of infection (otitic or sinus origin) Antibiotics should be administered in full doses parenterally (preferably intravenously) throughout the period of treatment Treatment failures with certain drugs, notably ampicillin, may be attributable to oral or intramuscular administration, resulting in inadequate concentrations in the CSF Repeated lumbar punctures are not necessary to assess the effects of therapy as long as there is progressive clinical improvement The CSF glucose may remain Table 32-3 Recommended dosages of antimicrobial agents for bacterial meningitis in adults with normal renal and hepatic functiona

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This next set of steps to get you started requires Visual Studio 2008 If you are using one of the Express versions of Visual Studio, be sure that any add-ons for LINQ are in place Also, you will need to:

.

1 Open a new Web Site, and name it ShowLinq 2 Open Solution Explorer and rename Defaultaspx to ShowLinqaspx

Now, let's add the helix to the graph'sright paneTo do this, we againemploy a para: and metl'icrepresentation: sin(/),)' cos(1), u : / x: ' > s u b p L o t ( I , 2 , 2 ) ; p 1 o t 3 ( s i n ( L ) , c o s ( 1 ) , L ); ,) >> rirle('(b) what'sgoingon As time evolves The resultis shownin Fig 2l b Can you visualize of the r and y coordinatessketchout the circumference the circle in the r-r' plane in the plot However simultaneously curverisesvertithe samefashionas the two-dimensional increases linearlywith time The net resultis the characteristic cally as the : coordinate of springor spiralstaircase shape the helix of Thele ale other f'eatrrres graphicsthat are useful-fbr exampleplotting obiects of instead lines,familiesol curvesplots,plottingon the complexplane,log-logor semilog next,a varietyof replots,three-dimensional meshplots,and contourplotsAs described to as solllces available learnaboutthese well as otherMATL,AB capabilities are

to treat almost all meningitides acquired outside the hospital, the initial choice of antibiotic has become increasingly complicated as resistant strains of meningitic bacteria have emerged The selection of drugs to treat nosocomial infections also presents special dif culties In recent years, many reports have documented an increasing incidence of pneumococcal isolates that have a relatively high resistance to penicillin, reaching 50 percent in some European countries Current estimates are that in some areas of the United States, 15 percent of these isolates are penicillin-resistant to some degree (most have a relatively low level of resistance) In the 1970s, H in uenzae type B strains producing beta-lactamase, which are resistant to ampicillin and penicillin, were recognized Currently, 30 percent of H in uenzae isolates produce the beta-lactamase enzyme, but almost all remain sensitive to third- and fourth-generation cephalosporins (cefotaxime, cefoperazone, ceftizoxime, etc) Recommendations for the institution of empiric treatment of meningitis have been reviewed by Quagliarello and Scheld and are summarized in modi ed form in Table 32-2 In children and adults, third-generation cephalosporins are probably the best initial therapy for the three major types of community-acquired meningitides In areas with substantial or increasing numbers of high-level penicillin-resistant pneumococci, consideration should be given to adding vancomycin and rifampin until the susceptibility of the isolate is established Ampicillin should be added to the regimen in cases of suspected Listeria meningitis When serious allergy to penicillin and cephalosporins precludes their use, chloramphenicol is a suitable alternative Isolation from the blood or CSF of a highly resistant organism requires the use of ceftriaxone, with the addition of vancomycin and rifampin N meningitides, at least in the United States, remains highly susceptible to penicillin and ampicillin Regional variations and ongoing antibiotic-induced changes in the infecting microorganisms underscore the need for constant awareness of drug re-.

( continued )

ol'MATLAB that we will be using The fbregoingwas designed lbcus on thosef'eatures to overviewof all in the remainder this bookAs suchit is obviouslynot a comprehensive of in rnore,you shouldconsultone If o1'MATLAB's capabilities you are interested learning and to of the excellent booksdevoted MAILAB (egPalrn2005;Hanselman Littlefield 2 0 0 5 :a n dM o o r e 2 0 0 7 ) by Help lacility thatcan be accessed itsell'includes extensive an Further, package the windowThis will provideyou with a nutnber clicking on the Help nrenuin the comnrand In thloughMATLAB's Help material adof ditl'erent optionsfbr exploringand searching detnos access a numberof instructive to dition, it prclvides rnodeby typing the in As described this chiLpter in help is also available interactive or fbllowedby the narne o1'acommand function lrclp conrmand If you do not know the narne,you can use the lookfor commandto searchthe suppose you wantto find all that of MATLAB Help files lbr occurrences textFol example, you and that relateto logarithrns, couldenter the cornrnands functions

Amikacin Ampicillin Cefepime Cefotaxime Ceftazidime Ceftriaxone Chloramphenicolc Cipro oxacin Gentamicinb Linezolid Meropenemd Nafcillin Oxacillin Penicillin G Quinupristan-dalfopristan Rifampine Tobramycinb Trimethoprim/sulfamethoxazole f Vancomycinb, g

inherit (inherits DoLinq)

anclMATLAB will displayall ret'erences includethe word loqrri t-hnr that lnc, websiteat wwwmathworks Finallyyou can obtainhelp tionr The MathWorks newsgroups, books,and technical Thereyou will l'indlinks to productinfbrmation, corn well as a varietyofother uselitlresources support as

15 mg/kg 12 g 4 6 g 12 g 6g 4g 6g 800 1200 mg 5 mg/kg 1200 mg 3 6 g 9 12 g 9 12 g 24 million units 225 mg/kg 600 mg 5 mg/kg 20 mg/kg 2 3 g