I am curious if members of the list would consider other SBIs as it
seems many do the pneumonia being discussed?
A few examples:
1. Otherwise normal 7 wk old female with fever 102F and Catheter UA
showing >50WBCs, a few RBCs, a positive nitrite, and GNRs on your
bedside Gram's stain. ;) Culture pending of course.
a. Would you do an LP on this child?
b. Would you treat with IV/IM antibiotic or give them oral cefixime
c. Admit? Next day follow up?
2. Somewhat ill appearing 16 month old typical RIA proven RSV
bronchiolitis, fever 102, oxygen requirement, and infiltrate in addition
to traditional viral pattern on chest film.
a. Would you do an LP on this child? Blood culture?
b. Would you give IV antibiotics and admit for monitoring? LP only
if not improving?
c. Would you just admit for RSV and discuss the evidence in this
area with the resident in a professorial manner:-).
3. Have any of you changed your LP practices based on recent
concerns about inducing meningitis in cases of bacteremia raised in Dr.
Baraff's article from a couple years ago? (Veterinarians can not answer
this question without stating the breed of dog you treat)
Thanks for your thoughts,
Randy Cordle MD
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