What Are the Indications for Repeated Lumbar Puncture in Patients with Bacterial Meningitis?
In patients with bacterial meningitis who have responded appropriately to antimicrobial therapy, repeated CSF analysis to document CSF sterilization and improvement of CSF parameters is not routinely indicated. Repeated CSF analysis should be performed, however, for any patient who has not responded clinically after 48 h of appropriate antimicrobial therapy (A-III). This is especially true for the patient with pneumococcal meningitis caused by penicillin-or cephalosporin-resistant strains, especially for those who have also received adjunctive dexamethasone therapy. The neonate with meningitis due to gram-negative bacilli should undergo repeated lumbar punctures to document CSF sterilization, because the duration of antimicrobial therapy is determined, in part, by the result (A-III). In patients with CSF shunt infections, the presence of a drainage catheter after shunt removal allows for monitoring of CSF parameters to ensure that the infection is responding to appropriate antimicrobia
