CSF culture from a 3-year-old with acute bacterial meningitis grows Streptococcus pneumoniae. Susceptibility results are pending, and local surveillance shows significant rates of penicillin-resistant pneumococci. Besides ceftriaxone, which drug should be part of the empirical regimen?
- A Gentamicin
- B Metronidazole
- C Vancomycin ✓
- D Rifampicin monotherapy
Correct answer: C. Vancomycin
Explanation
Where penicillin-resistant pneumococci are prevalent, vancomycin is added empirically to a third-generation cephalosporin until minimum inhibitory concentrations are available, because cephalosporin resistance correlates with penicillin resistance. Gentamicin adds nothing against pneumococcus and penetrates CSF poorly, metronidazole covers anaerobes relevant to brain abscess rather than meningitis, and rifampicin is never adequate monotherapy for bacterial meningitis.
Reference: Nelson Textbook of Pediatrics, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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