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End-of-Treatment Spinal Tap in Bacterial Meningitis: Title and subTitle BreakIs It Worthwhile? FREE

David T. Durack, MB, DPhil; Alan Spanos, MA, BM
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Reprint requests to Box 3867, Duke University Medical Center, Durham, NC 27710 (Dr Durack).


JAMA. 1982;248(1):75-78. doi:10.1001/jama.1982.03330010049030
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Examination of CSF at the end of treatment for bacterial meningitis is a common clinical practice. Because its value as a test of cure is questionable, we reviewed 165 cases in which a posttreatment spinal tap was done. Frequency distributions of spinal fluid findings are presented, showing that strikingly wide ranges of glucose and protein levels and cell counts at the end of treatment are compatible with cure. The CSF findings failed to provide a warning in the only two patients in whom treatment failure was diagnosed later. In 13 others, the results led to unnecessary intervention. These data indicate that the posttreatment lumbar puncture is usually valueless as a test of cure in bacterial meningitis and can do more harm than good.

(JAMA 1982;248:75-78)

REFERENCES

Yow MD:  Ampicillin in the treatment of meningitis due to Haemophilus influenzae: An appraisal after six years of experience . J Pediatr 1969;;74:848-852.
Farmer TW:  Intracranial infections , in Farmer TW (ed): Pediatric Neurology . New York, Harper & Row Publishers Inc, 1975;, pp 261-302.
Jacob J, Kaplan RA:  Bacterial meningitis: Limitations of repeated lumbar puncture . Am J Dis Child 1977;;131:46-48.
Wilson HD, Haltalin KC:  Ampicillin in Haemophilus influenzae meningitis: Clinicopharmacologic evaluation of intramuscular vs intravenous administration . Am J Dis Child 1975;;129:208-215.
Schaad UB, Nelson JD, McCracken GH:  Recrudescence and relapse in bacterial meningitis of childhood . Pediatrics 1981;;67:188-195.
Moffet HL:  Acute neurologic syndromes , in Pediatric Infectious Diseases . Philadelphia, JB Lippincott, 1975;, pp 136-183.
Harter DH, Merritt HH:  Infections , in Merritt HH (ed): A Textbook of Neurology . Philadelphia, Lea & Febiger, 1979;, pp 1-147.
Krugman S, Katz SL:  Acute bacterial meningitis , in Krugman S, Katz SL (eds): Infectious Diseases of Children . St Louis, CV Mosby Co, 1981;, pp 168-183.
Lansky LL: Pediatric Neurology . New York, Medical Examination Publishing Co, 1975;, pp 71-94.
Chartrand SA, Cho CT:  Persistent pleocytosis in bacterial meningitis . J Pediatr 1976;; 88:424-426.
Feigin RD:  Bacterial meningitis beyond the neonatal period , in Feigin RD, Cherry JD (eds): Textbook of Pediatric Infectious Diseases . Philadelphia, WB Saunders Co, 1981;, pp 293-308.

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Yow MD:  Ampicillin in the treatment of meningitis due to Haemophilus influenzae: An appraisal after six years of experience . J Pediatr 1969;;74:848-852.
Farmer TW:  Intracranial infections , in Farmer TW (ed): Pediatric Neurology . New York, Harper & Row Publishers Inc, 1975;, pp 261-302.
Jacob J, Kaplan RA:  Bacterial meningitis: Limitations of repeated lumbar puncture . Am J Dis Child 1977;;131:46-48.
Wilson HD, Haltalin KC:  Ampicillin in Haemophilus influenzae meningitis: Clinicopharmacologic evaluation of intramuscular vs intravenous administration . Am J Dis Child 1975;;129:208-215.
Schaad UB, Nelson JD, McCracken GH:  Recrudescence and relapse in bacterial meningitis of childhood . Pediatrics 1981;;67:188-195.
Moffet HL:  Acute neurologic syndromes , in Pediatric Infectious Diseases . Philadelphia, JB Lippincott, 1975;, pp 136-183.
Harter DH, Merritt HH:  Infections , in Merritt HH (ed): A Textbook of Neurology . Philadelphia, Lea & Febiger, 1979;, pp 1-147.
Krugman S, Katz SL:  Acute bacterial meningitis , in Krugman S, Katz SL (eds): Infectious Diseases of Children . St Louis, CV Mosby Co, 1981;, pp 168-183.
Lansky LL: Pediatric Neurology . New York, Medical Examination Publishing Co, 1975;, pp 71-94.
Chartrand SA, Cho CT:  Persistent pleocytosis in bacterial meningitis . J Pediatr 1976;; 88:424-426.
Feigin RD:  Bacterial meningitis beyond the neonatal period , in Feigin RD, Cherry JD (eds): Textbook of Pediatric Infectious Diseases . Philadelphia, WB Saunders Co, 1981;, pp 293-308.
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