This is mere anecdote, and not literally evidence...however, I am nearly
complete in writing a case report on a 7 week infant with URI and fever to
101, otherwise well, met all "low risk" criteria published, ( rochester,
philadelphia, boston, etc...) and had influenza A rapid test positive. Rec'd
ceftriaxone and sent home. Day 2, CSF grew klebsiella pneumonia. CT scan
2 weeks later revealed subdural effusions, consistent with post-meningitis.
There is really no way to exclude meningitis without an LP. Sorry! If no
antibiotics are to be given, one might want to watch and wait...but as for
me, I'd rather have the peace of mind a negative LP provides.
Shari Platt, MD
Director, Pediatric Emergency Service
New York Weill Cornell Medical Center
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