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November 12, 1982

Post-treatment Lumbar Puncture

JAMA. 1982;248(18):2241. doi:10.1001/jama.1982.03330180015022

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To the Editor.—  The article by Durack and Spanos (1982;248:75) on end-of-treatment spinal taps in bacterial meningitis is a persuasive demonstration of both the variability of spinal fluid findings after treatment and of the difficulty of using these findings to establish a "cure." However, there remains a rationale for continuing to perform these spinal taps. Frequently, within days to weeks of discharge, a patient returns with recurrent fever or other symptoms that suggest the possibility of relapse. At that time, spinal fluid findings may still be abnormal (in the absence of relapse). Without having the post-treatment measurements, evaluating these values is utterly impossible. On the other hand, knowing that abnormal values represent an improvement over immediate post-treatment values may be the only way to avoid an unnecessary readmission. Furthermore, faced with such a predicament, having a negative post-treatment culture is reassuring and, in my view, not at all unnecessary. Thus,