12th August 2024

A 70-year-old lady with a past medical history of type 2 diabetes mellitus, a previous stroke and peripheral vascular disease

A 70-year-old lady with a past medical history of type 2 diabetes mellitus, a previous stroke and peripheral vascular disease presents with a headache and confusion. On assessment she is febrile, drowsy, confused and slightly tachycardic. Her neurological examination shows a GCS of 14/15 (E4, V4, M6) but there is no evidence of neck stiffness or photophobia. IV ceftriaxone and is started as empirical treatment for suspected meningitis. Blood cultures are taken which later grow gram positive rods. A CSF sample shows raised WBC 168/mm³ (normal range 0-5) which are predominantly polymorphonuclear cells. The full results are still pending.

What would be the most appropriate treatment at this stage?

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