Paediatric Infections · NEET PG Preparation Paediatrics
A 3-week-old neonate presents with poor feeding, lethargy, and a bulging anterior fontanelle. A lumbar puncture is performed, and cerebrospinal fluid…
Practice question from Paediatric Infections (NEET PG Preparation Paediatrics), with the correct answer and a step-by-step solution.
hard · MCQ · Q-C730FD
A 3-week-old neonate presents with poor feeding, lethargy, and a bulging anterior fontanelle. A lumbar puncture is performed, and cerebrospinal fluid (CSF) analysis reveals pleocytosis with neutrophil predominance, low glucose, and high protein. Gram stain shows Gram-positive bacilli. Which of the following is the most appropriate empiric antibiotic regimen for this patient?
- A.Ampicillin plus CefotaximeCorrect answer
- B.Ceftriaxone plus Vancomycin
- C.Ampicillin plus Gentamicin
- D.Vancomycin plus Meropenem
Solution
Neonatal meningitis is most commonly caused by Group B Streptococcus, Escherichia coli, and Listeria monocytogenes. Because Listeria monocytogenes is a Gram-positive bacillus intrinsically resistant to cephalosporins (like cefotaxime/ceftriaxone), empiric coverage in neonates must include Ampicillin (for Listeria and GBS) combined with an aminoglycoside (like gentamicin) or a third-generation cephalosporin (like cefotaxime for Gram-negative bacilli). Note: Ceftriaxone is avoided in neonates due to hyperbilirubinemia risk, making Cefotaxime the preferred cephalosporin.
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