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19th June 2023
A 78-year-old male presents to A&E with a 6-day history of fever, headache, neck stiffness, photophobia, and confusion
A 78-year-old male presents to A&E with a 6-day history of fever, headache, neck stiffness, photophobia, and confusion. He has a background of diabetes and polymyalgia rheumatica, for which he is on regular metformin and low dose prednisolone. He lives with his wife and is independent with ADLs. On assessment, he is febrile at 38.2˚C, tachycardic at 108 bpm, BP is 128/60mmHg, and O2 saturations 97% on air.
On examination, he has neck stiffness and GCS 14 (E4V4M6) but no other focal neurology. No rashes are noted.
CT head is unremarkable, and an LP is performed.
CSF analysis:
| Appearance | Cloudy | |
| Protein | 0.55 g/L | (<0.45 g/L ) |
| Glucose | 2.0 mmol/L | (2.5-4.4 mmol/L ) |
| White cells | 300 cells/μL (predominantly polymorphs) | <5 cells/μL |
| Gram stain and culture | Pending | |
Of the following options, which is the most appropriate antibiotic regimen to start pending the results of the CSF culture?
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