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July 2, 1982

End-of-Treatment Spinal Tap in Bacterial Meningitis: Is It Worthwhile?

Author Affiliations

From the Department of Medicine, Division of Infectious Diseases, Duke University Medical Center, Durham, NC.

JAMA. 1982;248(1):75-78. doi:10.1001/jama.1982.03330010049030

Examination of CSF at the end of treatment for bacterial meningitis is a common clinical practice. Because its value as a test of cure is questionable, we reviewed 165 cases in which a posttreatment spinal tap was done. Frequency distributions of spinal fluid findings are presented, showing that strikingly wide ranges of glucose and protein levels and cell counts at the end of treatment are compatible with cure. The CSF findings failed to provide a warning in the only two patients in whom treatment failure was diagnosed later. In 13 others, the results led to unnecessary intervention. These data indicate that the posttreatment lumbar puncture is usually valueless as a test of cure in bacterial meningitis and can do more harm than good.

(JAMA 1982;248:75-78)