[Sabio]

Recently one of our Facebook page members was asking when should we give the antibiotic for a patient with meningitis.

Is it before or after the LP? Is it before or after the CT scan?

Let's start a discussion here

 

[donofitaly]

Shouldn't ATBs be given after LP unless its a emergency situation?

 

[malarneela]

start antibiotics emprically

if meningitis is strongly suspected then better to start antibiotics before LP.. and CT shud be taken before lumbar punture

 

[khanar]

Here's how to answer the question

Agree with malarneela above.
In the USMLE exam you have to make sure first that it's a case of meningitis (fever, vomiting, nuchal rigidity, rash, ...etc).
If this is correct then give the IV antibiotic shot immediately and then arrange for LP and/or CT scan.
If there are signs of raised intracranial pressure (papilledema, headache, respiratory compramise, cushin triad, ...etc) then don't do the LP, instead order CT scan.
If there are signs that make the diagnosis of meningitis questionable then do CT first before doing anything else.

PS- thank you Sabio, this is a great topic to discuss

 

[khanar]

You will not ruin your LP if you give AB first

Furthermore, do not worry about masking the CSF results if you give the antibiotics first, because it takes 45 minutes for the antibiotic to reach the CSF and by the time you should have done the LP