Evaluating Fever, Headache, and Confusion in a Teenage Girl

In Episode 35 of Med School Question of the Week for USMLE, Faustine Ramirez, MedSchoolCoach expert tutor, answers this medical school question: A 16-year-old girl is brought to the emergency room with 3 days of fever, headache, confusion, and sleepiness. She has no significant past medical history. Her family recently immigrated to the United States. Temperature is 39.5 C, heart rate is 130/min, respiratory rate is 30/min, and blood pressure is 135/80. On examination she is somnolent but arousable, oriented to person and place but not to time, and she has nuchal rigidity. Blood cultures are pending. A lumbar puncture is performed, and CSF analysis demonstrates:

• Opening pressure: 280 mm H2O
• Glucose: 25
• Protein: 180
• WBC: 3000 (PMNs: 90%; Lymphocytes: 10%)
• RBC: 50

What is the most appropriate pharmacotherapy?

• Ampicillin and gentamicin
• Ampicillin and cefotaxime
• Piperacillin and ciprofloxacin
• Piperacillin and ceftriaxone
• Vancomycin and ceftazidime
• Vancomycin and ceftriaxone