Clinical comparison of cefuroxime axetil and amoxicillin/clavulanate in the treatment of patients with acute bacterial maxillary sinusitis: Camacho AE, Cobo R, Otte J, et al Am J Med 93:271–276 Sep 1992

✍ Scribed by Torrey Goodman

• Publisher: Elsevier Science
• Year: 1993
• Tongue: English
• Weight: 99 KB
• Volume: 22
• Category: Article
• ISSN: 1097-6760
• DOI: 10.1016/s0196-0644(05)80232-x

✦ Synopsis

randomly selected as controls. Conventional clinical features were chosen as clinical indicators of meningitis and were assessed an odds probability of meningitis. Major signs included complex seizure history (focal seizure for more than 15 minutes, multiple seizures); complex general history (three or more days of illness, drowsiness at home, and vomiting); petechiae; definite nuchai rigidity; and coma. Minor signs included dubious nuchal rigidity, convulsing on examination, paresis, or paralysis on examination. One hundred seventy-one (65%) of the patients underwent lumbar puncture. Of the,23 patients with meningitis, 16 were identified by the major signs. The authors suggest that the remaining seven would have been discovered in close follow-up. The authors state that a seizure duration of 15 minutes or more and a history of drowsiness at home were especially indicative of meningitis. In the 45% of their patients who underwent negative lumbar puncture, the authors suggest that meningitis could have been excluded on clinical grounds. The authors state that if lumbar punctures had been done based on their major and minor signs, 234 punctures would have been done and 75 children would have been spared a lumbar puncture. The authors conclude that detection of meningitis in febrile children with a first seizure can be determined on clinical grounds and that routine lumbar puncture is not needed provided close follow-up or clinical observation in the ED is allowed.