I agree with you about the outpatient management of aseptic meningitis. T=
he key in these cases is
as to make the differencial diagnosis about the etiology of the meningiti=
s. In our experience
aseptic meningitis is managed as outpatient in more than 90% of cases. Mo=
st patients stay in the
observation unit during less than 24 hours. Clinical picture appart, anot=
her toils can help us to
take decissions. The evolution of CRP (C-reactive protein) levels during=
the first hours and the
PCR (protein chain reaction) for enteroviruses in CSF could be hepful in =
the management of any
[log in to unmask]
Urgencias de Pediatr=EDa. Hospital de Cruces
Bilbao - Basque Country
jay pershad wrote:
> -"All non-medical issues aside, what do others feel about the outpatien=
> > treatment of meningits? Assuming this was viral, but still administer=
> > antibiotics until cultures are negative, is there any difference in
> > whether this child received his IV Rocephin in the hospital or as an
> > outpatient?"
> I think the key is what you said about the likely etiology of this
> meningitis. Given the time of the year, non toxic exam and a CSF pictur=
> c/w mild aseptic meningitis ( i assume the gram stain is also negative =
> the patient has not been on any prior PO antibiotics ) , this is indeed=
> viral menigitis. Whether the patient get's ABx or not, is unlikely to
> make a difference in this case!!
> Personally, giving Rocephin is not what I would do as an outpatient. I
> would send the patient home with no meds(other than analgesia), with cl=
> FU, after d/w family of course the reasons for the course of action. If=
> is treating for possible bacterial
> meningitis then outpatient management is certainly NOT what I would do.
> Also,if you are treating for presumed bacterial disease, "Rocephin" alo=
> not standard of care in this day and age of resistant pneumococcal dise=
> (See task force on use of vancomycin in bacterial meningitis in Pediatr=
> last year)
> -"He assured me he would inform the regular pediatrician of
> > the case."
> If you have a disagreement with the consultant don't feel compelled to
> follow their recommendation!! You can have them personally evaluate the
> patient and discharge the patient themselves.
> BTW, there is a confounding variable in this case. The "unknown" exposu=
> to meningitis might make me admit this patient, unless I can clarify th=
> issue. What if the exposure was to meningococcal meningitis say ????
> Lastly, if you consider the average weight of a 12 year old to be say 5=
> kg (or basically an adult) the dose of 1 gram of Ceftriaxone administer=
> if I am not mistaken, is below that recommended for bacterial meninigit=
> The latter is 75 mg/kg or 2 gms.
> PS: You might want to also check the archives of this list in the last =
> of June for an extensive discussion of Mx of "aseptic" meningitis. I do
> recall considerable disagreement in this area between members of the li=
> so, your quandary is certainly shared by many!!
> Jay Pershad, M.D.
> "We care for wee folks"
> For more information, send mail to [log in to unmask] with the =
message: info PED-EM-L
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