Correct!
3. Lumbar puncture (LP)
There are no signs or symptoms of prostatitis and a needle biopsy of the prostrate is inappropriate. It was common to perform a CT scan before a LP to exclude a space occupying lesion and potential brainstem herniation. However, in adults with suspected meningitis, clinical features can be used to identify those who are unlikely to have abnormal findings on CT of the head (1). These include an age of at least 60 years, immunocompromise, a history of central nervous system disease, and a history of seizure within one week before presentation, as well as the following neurologic abnormalities: an abnormal level of consciousness, an inability to answer two consecutive questions correctly or to follow two consecutive commands, gaze palsy, abnormal visual fields, facial palsy, arm drift, leg drift, and abnormal language (e.g., aphasia).
Based on his slight confusion an LP was performed which was initially colorless, but became pink-tinged as cerebrospinal fluid was withdrawn – it did not clear as further samples were acquired. There were 13,093 RBC, 294 WBC (17% segmented, 70% lymphocytes, and 13% monocytes), glucose was 61 and protein 123. Gram stain is negative.
Which of the following antibiotics should be empirically administered?