Consider Dexamethasone and Remdesivir for moderate-severe infections
Most patients can be discharged if healthy, vaccinated, and hemodynamically stable
Admission is necessary for patients with tachypnea, hypoxia, or with significant comorbidities.
Paxlovid (nirmatrelvir/ritonavir) is an oral antiviral drug that can be used for mild/moderate COVID-19 infections. However, it cannot be used in patients with severe renal disease (GFR < 30) and it has several drug interactions.
The current dominant variant (Omicron) is more transmissible and resistant to vaccines/monoclonal therapy than it’s predecessor (Delta), but overall causes less hospitalization and severe disease.
Inflammation of the meninges and subarachnoid space. May be bacterial (most lethal), viral (most common), or in rare cases due to fungal or tuberculosis infection.
Bacterial meningitis is most commonly caused by Streptococcus pneumoniae
Fever, headache, nuchal rigidity, photophobia
(+) Brudzinski sign, (+) Kernig Sign
Lumbar puncture w/ CSF fluid analysis
Broad-spectrum antibiotics (ex. Ceftriaxone + Vancomycin) and corticosteroids (ex. Dexamethasone)
If viral, treat with Acyclovir
Admission is required for any known/suspected bacterial infections. ICU is required for any toxic-appearing patients.
Discharge with close follow-up is appropriate if the infection is clearly viral and symptoms are controlled.
When in doubt, just do the lumbar puncture! Failure to diagnose meningitis early can be life-threatening and often results in medicolegal consequences for providers.
Although a head CT is often performed prior to lumbar puncture, this can cause a significant delay in diagnosis/treatment. Reserve early CT imaging for patients with AMS, neurological deficits, papilledema, or history of CNS disease.
Obtain bone cultures prior to initiating antibiotics
Admission is usually required.
Some cases of chronic or subacute osteomyelitis can be managed outpatient if debridement not needed and home IV antibiotics can be arranged.
The WBC count is often normal, especially in pediatric or subacute/chronic cases.
Osteomyelitis can be difficult to diagnose in pediatrics (they often present afebrile with no leukocytosis). However,the combination of ESR and CRP elevation has a 98% sensitivity for diagnosing osteomyelitis in the pediatric population.