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Meningitis Not Improving After IV Antibiotics 

Meningitis Not Improving After IV Antibiotics
Meningitis Not Improving After IV Antibiotics
Neurocritical Care (2 ed.)

Eelco F. M. Wijdicks

, Alejandro A. Rabinstein

, Sara E. Hocker

, and Jennifer E. Fugate


Outcome in acute bacterial meningitis is dependent on early initiation of antibiotic treatment; it needs to be treated aggressively with corticosteroids and broad-spectrum antibiotics as early as possible. This chapter discusses the pros and cons of corticosteroids and choice of antibiotics. It also discusses how to rapidly assess the severity of the illness using neuroimaging and cerebrospinal fluid examination and how to find the source. Patients may not improve due to cerebral infarcts or severe meningeal inflammation causing hydrocephalus. Patients may need time to recover after a severe bout and early transition to palliative care only may be inappropriate, except for patients with refractory sepsis and multiorgan failure.

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