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I'll admit I'm much too chicken to treat meningitis, regardless of the
gestalt for viral vs. bacterial, without antibiotic coverage until the
cultures are negative at 48 hours and the child is doing better. What is
the savings? $100 of Rocephin? There are physicians who phone in that
much Biaxin, without even seeing the patient, for a "bad cough" of two
days duration. Economically, even if you are right 99% of the time about
it being viral, the one bacterial case you miss will dwarf the savings
in dollars. And meningitis is so rare compared to other things we treat,
I doubt the practice will affect resistance patterns.
 
As to the outpatient therapy idea, I have to admit that most cases of
viral meningitis gain little by being in the hospital at X00 $/day, just
to get Rocephin q24h. But seizures do occur. SIADH does occur. Confusion
does occur (with meningoencephalitis). How often? I don't have numbers.
But these all are potentially dangerous situations at home. So until the
common practice clearly changes, I continue to observe the child at
least a couple days in house. No studies to back this up, but outpatient
management doesn't have any literature support either.
 
Kevin Powell MD PhD
University of Illinois, Urbana
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