Monitoring
Repeat lumbar punctures to monitor treatment are not necessary if the patient is improving.
Indications for repeated lumbar puncture include no clinical response after 48 hours of appropriate antimicrobial therapy; gram-negative bacilli in neonates (to document cerebrospinal fluid sterility); and cerebrospinal fluid shunt infection (to ensure that the infection is responding to therapy).[65]
How to perform a diagnostic lumbar puncture in adults. Includes a discussion of patient positioning, choice of needle, and measurement of opening and closing pressure.
In all children who have had bacterial meningitis, hearing should be tested before discharge from the hospital or within 4 weeks of discharge. For those with severe to profound hearing loss, a cochlear implant may be necessary, which should be placed as soon as the child has recovered from the acute stage of meningitis. Although formal testing for cognitive, academic, and behavior problems is not generally necessary, it is important to monitor the child's progress over time. All patients should be reviewed once a year to detect any long-term sequelae.
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