Dr. Deepak Patel
Child Health
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Patient's Query
Hello doctor,
My one year old daughter had a fever for four days, with one episode of seizure on the fourth day which lasted less than a minute. There was no post ictal confusion or drowsiness. At first, the doctors started with Ceftriaxone and Amikacin for four days, then a lumbar puncture was done showing leucocytes. The report said 135 with 80 % lymphocytes and 20 % monocytes. The day before lumbar puncture, she was started on Vancomycin. The blood culture done before starting Ceftriaxone showed Staphylococcus growth with 50 thousand colonies. They said it may be contaminated. Urine culture showed enterococcus faecium, but repeat test came negative. All subsequent tests came negative. Now the child is doing well, without fever for four days. They stopped both Vancomycin and Amikacin and told to continue Ceftriaxone for two weeks. I am awaiting the CSF culture reports. My concern is whether it is alright not to give Vancomycin.
Hello,
Welcome to icliniq.com.
I can understand your concerns.
From the symptoms and investigations, your child is most probably having meningitis. The first line of treatment is Ceftriaxone and Amikacin. This covers the most common organism for meningitis at this age. The blood culture which showed Staphylococcus is most probably a contaminant because a Staphylococcus infection spreads very rapidly. In most of the conditions, the blood culture takes into account the skin contaminant. We have to look at it from a clinical point of view. Clinically, the child does not seem to have a staphylococcal infection. In which case, the condition becomes much worse in a very short time. I think that your child is getting treated correctly, and there is no need of adding Vancomycin.
I hope this helps. Take care.
Patient's Query
Thank you doctor
We have been giving Ceftriaxone and Amikacin for eight days now. They have told us to stop Amikacin and continue only Ceftriaxone for another week. So, is that fine?
Hi,
Welcome back to icliniq.com.
This is absolutely fine. A seven-day course of Amikacin and a 14-day course of Ceftriaxone will ensure complete eradication of the causative organism.
There is nothing to worry. Take care.
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Child Health
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