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Meningococcal meningitis — MCCQE Part 1 MCQ

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HardHeadacheMeningococcal meningitisMCCQE Part 1

A 62-year-old taking adalimumab presents with fever, confusion, neck stiffness and a new petechial rash. Blood pressure is 88/54 mmHg. There is no focal neurologic deficit, but lumbar puncture cannot be performed immediately. Which antimicrobial plan is most appropriate?

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Correct answer: B — Give dexamethasone with ceftriaxone, vancomycin and ampicillin immediately

Give ceftriaxone alone after cranial CT excludes raised intracranial pressure: Ceftriaxone alone omits both resistant-pneumococcal and Listeria coverage, and CT must not delay treatment. Give dexamethasone with ceftriaxone, vancomycin and ampicillin immediately: Ceftriaxone plus vancomycin covers common resistant pathogens, ampicillin adds Listeria coverage, and dexamethasone should precede or accompany the first antibiotic dose. Give acyclovir alone until cerebrospinal-fluid PCR results are available: Acyclovir is added when encephalitis is plausible but cannot replace empiric bacterial therapy in septic meningitis. Give piperacillin-tazobactam alone after lumbar puncture has been completed: Piperacillin-tazobactam is not the standard empiric meningitis regimen and treatment should not await lumbar puncture. Give oral amoxicillin-clavulanate while awaiting an inpatient bed: Oral therapy is inadequate for a shocked patient with a central nervous system infection.

Reference: https://emergencycarebc.ca/clinical_resource/clinical-summary/meningitis-diagnosis-and-treatment/