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You create user accounts from the System Preference application (available from the Dock or within /Applications), using the Users pane (see figure 2.5). When you create a user, you can assign normal privileges or administrator privileges, but not root. There are two primary ways to permit root privileges under Mac OS X: by using the sudo ( soo-doo ) command and by directly enabling the root account.

The cerebrospinal fluid typically has more than 1000 white blood cells per microliter, over 60% of which are polymorphonuclear leukocytes; the glucose concentration is less than 40 mg/dL, or less than 50% of the simultaneous serum concentration; and the protein usually exceeds 150 mg/dL Not all cases of meningitis will have these typical findings, and alterations in cerebrospinal fluid cell counts and chemistries may be surprisingly minimal, overlapping with those of aseptic meningitis Gram stain of cerebrospinal fluid shows gram-positive cocci in 80 90% of cases, and in untreated cases, blood or cerebrospinal fluid cultures are almost always positive

Within the body of the method, the parameters act as local variables, as though you had declared them in the body of the method and initialized them with the values passed in. Example 7-2 illustrates how you pass values into a method; in this case, values of type int and float.

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Antibiotics should be given as soon as the diagnosis is suspected If lumbar puncture must be delayed (eg, while awaiting results of an imaging study to exclude a mass lesion), the patient should be treated empirically for presumed meningitis with intravenous ceftriaxone, 2 g, plus vancomycin, 15 mg/kg, plus dexamethasone, 015 mg/kg administered concomitantly after blood cultures (positive in 50% of cases) have been obtained Once susceptibility to penicillin has been confirmed, penicillin, 24 million units intravenously daily in six divided doses, or ceftriaxone, 2 g every 12 hours intravenously, is continued for 10 14 days in documented cases The best therapy for penicillin-resistant strains is not known Penicillin-resistant strains often are cross-resistant

to the third-generation cephalosporins as well as other antibiotics Susceptibility testing is essential to proper management of this infection Treatment failures have been reported with ceftriaxone or cefotaxime for meningitis caused by strains with penicillin MICs 2 mcg/mL If the MIC of ceftriaxone or cefotaxime is 05 mcg/mL, singledrug therapy with either of these cephalosporins is likely to be effective; when the MIC is 1 mcg/mL, treatment with a combination of ceftriaxone, 2 g intravenously every 12 hours, plus vancomycin, 30 mg/kg/d intravenously in two or three divided doses, is recommended If a patient with a penicillin-resistant organism is slow to respond clinically, repeat lumbar puncture may be indicated to assess bacteriologic response Dexamethasone administered with antibiotic to adults has been associated with a 60% reduction in mortality and a 50% reduction in unfavorable outcomes, primarily in patients with pneumococcal meningitis It is recommended that adults with acute bacterial meningitis be given 10 mg of dexamethasone intravenously immediately prior to or concomitantly with the first dose of appropriate antibiotic and continued in those with pneumococcal disease every 6 hours thereafter for a total of 4 days The effect of dexamethasone on outcome of meningitis caused by penicillin-resistant organisms is not known

Torpy JM et al JAMA patient page Pneumococcal diseases JAMA 2006 Apr 12;295(14):1730 [PMID: 16609100] Weisfelt M et al Dexamethasone treatment in adults with pneumococcal meningitis: risk factors for death Eur J Clin Microbiol Infect Dis 2006 Feb;25(2):73 8 [PMID: 16470361]

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S aureus skin infections may begin around one or more hair follicles, causing folliculitis; may become localized to form boils (or furuncles); or may spread to adjacent skin and deeper subcutaneous tissue (ie, a carbuncle) Deep abscesses involving muscle or fascia may occur, often in association with a deep wound or other inoculation or injection Necrotizing fasciitis, a rare form of S aureus skin and soft tissues infection, has been reported with community strains of methicillin-resistant S aureus

Cultures of the wound or abscess material will almost always yield the organism In patients with systemic signs of infection, blood cultures should be obtained because of potential endocarditis, osteomyelitis, or metastatic seeding of other sites Patients who are bacteremic should have blood cultures taken early during therapy to exclude persistent bacteremia, an indicator of severe or complicated infection

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