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I had a 12 year old boy come to the ED the other day around 6 AM on a
Friday. 18 hours earlier he had the onset of HA and fever with no other
symptoms of any kind. His mother was concerned because he had been
exposed to a neighborhood child with meningitis last week. She was not
sure if it was viral or bacterial and knows no other details, but that
child was now doing well apparently. This patient was nontoxic, no
photophobia, no nausea or vomiting, just simply a mild to moderate HA
and fever.
 
I did an LP which showed 37 WBC's, 48% segs, 40% lymphs, 7% monos,
normal glucose, sl elevated protein. I sent blood and CSF cultures and
gave him 1 gram of Rocephin IV. I had already given him 1 Vicodin which
nearly resolved his HA. I called his HMO pediatric group to arrange
admission and the on call pediatrician wanted to treat him as an
outpatient. He wanted us to leave a heplock in place and have him come
back for the next 2 days (over the weekend) and receive a gram of
Rocephin daily, have a recheck done at that time, have the cultures
followed at that time, and then have followup on Monday with his regular
pediatrician. He assured me he would inform the regular pediatrician of
the case.
 
All non-medical issues aside, what do others feel about the outpatient
treatment of meningits? Assuming this was viral, but still administering
antibiotics until cultures are negative, is there any difference in
whether this child received his IV Rocephin in the hospital or as an
outpatient? Again, this child did not appear toxic or even very ill. I
clearly would never consider this in a toxic, vomiting, or ill-appearing
child, but this was not the case with this patient.
--
Daniel E. Kates, M.D.
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Thunderbird Samaritan Medical Center
Phoenix, Arizona
U.S.A.
 
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