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Acute bacterial meningitis — ABIM Board MCQ

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HardInfectious DiseaseAcute bacterial meningitisABIM Board

A 69-year-old man with diabetes and chronic otitis media has fever, headache, confusion, and neck stiffness. Blood pressure is 138/76 mm Hg. CSF shows 2,400 leukocytes/mm3 with neutrophil predominance, glucose 24 mg/dL, and protein 220 mg/dL. Gram stain is pending. Which of the following is the most appropriate empiric treatment?

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Correct answer: A — Vancomycin, ceftriaxone, ampicillin, and dexamethasone

Older adults with suspected bacterial meningitis require empiric coverage for pneumococcus, meningococcus, and Listeria with vancomycin, ceftriaxone, and ampicillin; dexamethasone is given with or before the first antibiotic dose when pneumococcal meningitis is possible.

Reference: IDSA Bacterial Meningitis Guideline