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A repeat cerebrospinal fluid exam should be done in patients in whom
there is doubt about the success of therapy or the accuracy of the initial diagnosis.
Patients who respond promptly to therapy may no longer need repeat CSF exams. Monitor
for hydrocephalus and treat the condition appropriately. Hydrocephalus usually
manifests within the first few weeks of infection and is treated with
ventriculoperitoneal shunting. Monitor for neurologic sequelae and provide
appropriate supportive therapy. Neurologic sequelae include hearing impairment,
cranial nerve palsies and motor deficits. Supportive therapy should be
individually tailored.
Meningitis - Acute, Bacterial_Follow UpIn adults with meningococcal infection treated with antibiotics other than third-generation cephalosporins, give either Rifampicin (600 mg PO 12 hourly for 48 hours), Ciprofloxacin (500 mg PO as single dose) or Ceftriaxone (1g IV/IM as single dose) for eradication of nasopharyngeal colonization. These include patients aged >60 years, those with elevated CSF pressure, presence of focal neurological deficits, seizures, presence of debilitating disorders, low admitting Glasgow coma score, low CSF cell count, and low CSF to glucose ratio. Referral to a neurologist should be done if there is the presence of persistent neurologic deficits.