LUMBAR PUNCTURE AT THE END OF TREATMENT FOR BACTERLAL MENINGITIS: BASELINE FOR SUBSEQUENT DIAGNOSTIC LUMBAR PUNCTURE

Abstract

Cerebrospinal fluid (CSF) values at the end of successful treatment for bacterial meningitis are frequently abnormal. Performance of a lumbar puncture (LP) at the end of treatment has recently been discouraged because this LP does not identify the rare patient who will relapse. However, an LP at the end of treatment may provide critical baseline CSF values if a subsequent diagnostic LP is performed.This retrospective study was undertaken to determine how often children were seen for an acute illness after treatment for bacterial meningitis and how frequently diagnostic LPs were done. Forty eight patients three years old or younger treated for bacterial meningitis (1977-1981) were studied. Follow-up information regarding physician visits within the two weeks following hospitalization was obtained for 44 of 48 eligible children.LPs performed at the end of treatment had one or more abnormal values in 25 (75%) of 34 patients. Eleven (25%) of 44 children were seen by a physician for an acute illness during the two weeks after completion of treatment. A diagnostic LP was performed in four (12%) of the 33 infants under one year of age. LP results at the end of treatment were needed in the management of two of these infants.The frequency of acute illnesses and diagnostic LPs in the two weeks after treatment of meningitis suggests the continuing need for an end-of-treatment LP to provide baseline information.