Print

Print


-"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?"
 
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 picture
c/w mild aseptic meningitis ( i assume the gram stain is also negative and
the patient has not been on any prior PO antibiotics ) , this is indeed a
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 close
FU, after d/w family of course the reasons for the course of action. If one
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" alone
is
not standard of care in this day and age of resistant pneumococcal disease.
(See task force on use of vancomycin in bacterial meningitis in Pediatrics
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" exposure
to meningitis might make me admit this patient, unless I can clarify this
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 50-60
kg (or basically an adult) the dose of 1 gram of Ceftriaxone administered,
if I am not mistaken, is below that recommended for bacterial meninigitis.
The latter is 75 mg/kg or 2 gms.
 
PS: You might want to also check the archives of this list in the last week
of June for an extensive discussion of Mx of "aseptic" meningitis. I do
recall considerable disagreement in this area between members of the list,
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
The URL for the PED-EM-L Web Page is:
  http://www.brown.edu/Administration/Emergency_Medicine/ped-em-l.html