Hi,

Thanks for your query.

I wish you must have told me the age of the patient. Ideally cerebrospinal fluid (CSF) must be sent before instituting the empirical therapy. And viral meningitis is managed predominantly by supportive treatment like fluids, antipyretics, antiemetics etc and in some cases antivirals like acyclovir can be given.

Here there are two problems, first patient declined LP and second there is some chances (10%) to be a bacterial meningitis. Guidelines say if in a strongly suspected viral meningitis, if there is any chance of bacterial meningitis empirical anitbiotics should be started without waiting for pending CSF culture results. So accordingly, in my opinion it is better to go for empirical antibiotic as mentioned below.

1) Infants <1 months: ampicillin plus cefotaxime.
2) Infants 1-3 months: ampicillin plus cefotaxime/ceftriaxone.
3) Children >3 month and adult < 55 years :cefotaxime/ceftriaxone/cefepime plus vancomycin.
4) Adults >55 years or of any age with alcoholism or other debilitating illness: Ampicillin plus cefotaxime/ceftriaxone/cefepime plusvancomycin.
5) Hospital acquired or post traumatic meningitis: meropenem plus vancomycin

Hopefully I have answered your question.

Best wishes

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