22nd May 2025

A 54-year-old man with a background of diabetes and non-alcoholic fatty liver disease presents with a 6-day history of fever, headache and photophobia.

A 54-year-old man with a background of diabetes and non-alcoholic fatty liver disease presents with a 6-day history of fever, headache and photophobia. On examination, you elicit nuchal rigidity, a 7th cranial nerve palsy and a GCS 13/15. Chest and abdomen examination appear normal. Paramedics mentioned that he had a seizure lasting 2 mins in the ambulance. A CT head shows early changes of hydrocephalus. Bloods show a Haemoglobin of 13 g/L, WCC: 17 x10⁹/L, neutrophils: 13x 10⁹/L. The remainder of bloods are largely unremarkable other than an ALT of 300. Gram positive rods are seen on CSF microscopy.

What is the most appropriate treatment for this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.