A 22-year-old university student presents with sudden fever, severe headache, neck stiffness, and photophobia. What is the most appropriate empirical intravenous antibiotic regimen while awaiting CSF analysis?
Answer and explanation
Correct answer: B. Intravenous ceftriaxone plus vancomycin plus dexamethasone
- Step 1: The clinical triad of fever, neck stiffness, and altered mental status or headache indicates acute bacterial meningitis.
- Step 2: Standard empirical therapy for adults under 50 is third-generation cephalosporin (ceftriaxone) plus vancomycin (covering resistant Streptococcus pneumoniae).
- Step 3: Adjunctive dexamethasone given before or with the first antibiotic dose reduces neurological sequelae and mortality in pneumococcal meningitis.
Answer
Intravenous ceftriaxone plus vancomycin plus dexamethasone.
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