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Old 08-11-2012
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Kids LP or Antibiotics for child with meningitis?

In pediatrics portion of UW, it says that 1st step in suspected case of meningitis is LP as herniation is less likely to occur in infants less than 1 year old bcoz fontanells have not closed....

now MTB 3 Pg 374 under section of meningitis, the answer to question is empiric antibiotics though the child is just 5 months old having bulging fontanells....

which one to follow ???
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First LP and blood cultures and then antibiotics. Do CT if suspected ICP elevation like papiledema or focal neuro signs. That is what UW says.
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Originally Posted by LatinGeorge View Post
First LP and blood cultures and then antibiotics. Do CT if suspected ICP elevation like papiledema or focal neuro signs. That is what UW says.
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so u mean to say 1st step shud be LP with or without bulging fontanelles......???
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Originally Posted by K06100 View Post
so u mean to say 1st step shud be LP with or without bulging fontanelles......???
bulging frontanelles, do CT > LP> BC> Anti-Biotics
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Quote:
Originally Posted by shima View Post
bulging frontanelles, do CT > LP> BC> Anti-Biotics
pg 374 MTB 3, answer given is empiric antibiotics though CT scan is also given on option........is that wrong ??
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Originally Posted by K06100 View Post
pg 374 MTB 3, answer given is empiric antibiotics though CT scan is also given on option........is that wrong ??
What that means is that you give Abs first since CT is not going to help make the diagnosis i.e. you can't C/S a CT.

Most likely, you won't be faced with this scenario in the real exam as they have to stay away from the controversy. Therefore, you won't have a question in which you will be given both choices i.e. in a child with bulging fontanelles--So the choices will be like:
1. Do an LP
OR
Do a CT/MRI
2. Give Abs
3. Send BC
4. Urine CS
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Originally Posted by K06100 View Post
pg 374 MTB 3, answer given is empiric antibiotics though CT scan is also given on option........is that wrong ??
The fact of the matter is that antibiotics should be given fast! but LP and blood cultures are more important at first. If increased ICP, start antibiotics and do CT, then you can do LP. That's what i understand from UW the question number is in my previous post.
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This is what I summarized --

1.Normally--LP>BC>Antibiotics

2.In case of increased ICP--BC>Antibiotics>LP(when ICP lowers)

3.If CNS anatomical defect or prior neurosurgical operation--CT/Antibiotics first,then LP.......

4.In all cases blood culture(BC) shud always be done prior to administrating antibiotics........
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Quote:
Originally Posted by K06100 View Post
This is what I summarized --

1.Normally--LP>BC>Antibiotics

2.In case of increased ICP--BC>Antibiotics>LP(when ICP lowers)

3.If CNS anatomical defect or prior neurosurgical operation--CT/Antibiotics first,then LP.......

4.In all cases blood culture(BC) shud always be done prior to administrating antibiotics........
No, giving Abs is the first step when the clinical suspicion is high. Blood culture can be done if you are not sure of the diagnosis. BC is not a necessary test unless you are not sure of the diagnosis (Fever of Unknown origin)
If LP cannot be done immediately then you give Abs and then do LP (after Ct/MRI to rule out any other intra-cranial pathology) and then you can do Latex agglutination test (bacterial antigen detection test) on CSF.

Bottomline: Treatment is more important than getting a definitive microbiological diagnosis.
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Originally Posted by Novobiocin View Post
No, giving Abs is the first step when the clinical suspicion is high. Blood culture can be done if you are not sure of the diagnosis. BC is not a necessary test unless you are not sure of the diagnosis (Fever of Unknown origin)
UW mentions that u do BC in case of suspected case of meningitis before giving antibiotics......
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You are suppose to normally BASE your tx on cell count (more easily available than a complete culture).

So unless pt has c/i to LP, do LP -> send CSF to lab for stat cell count. Meanwhile you can administer -asone/ampi/vanco empirically, and when you get your cell count back (usually within minutes as its considered red level priority in ED's), you change your Abx.

If there is c/i to LP, than tx than you do a CT to r/u mass etc.
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Old 08-12-2012
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In Case of suspected Meningitis..The dictum is to give antibiotics as early as possible...Investigations should not delay the treatment...

Empericaly aantibiotic Vanco + Ceftriaxone - Cahnge later with culture.

CSF Picture is not going to change in 24 hrs after starting treatment.

No need for CT in infants with open AF.

I think If LP not done Blood culture initially then Antibiotics..
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@
K06100

can u please summarize now FINALLY ? after other members comments...whats final conclusion ?
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guys check these guidelines

http://www.uphs.upenn.edu/bugdrug/an...gitisNov04.pdf
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can't post guideline link.. you can google ..

Practice Guidelines for the Management of Bacterial Meningitis
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this exam wont trick you, the answers we all give are correct
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