American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment is recommended for meningitis following neurosurgical procedures?

1. IV ampicillin plus acyclovir

2. IV vancomycin plus either IV ceftazidime, cefepime, or meropenem

3. IV moxifloxacin

4. IV cefuroxime

The correct answer is: IV vancomycin plus either IV ceftazidime, cefepime, or meropenem

The recommended treatment for meningitis following neurosurgical procedures is indeed a combination of intravenous vancomycin along with either intravenous ceftazidime, cefepime, or meropenem. This approach is guided by the need to cover both gram-positive and gram-negative organisms that are commonly implicated in post-neurosurgical infections. Meningitis following neurosurgical interventions often involves pathogens such as Staphylococcus aureus, including methicillin-resistant strains (MRSA), as well as various gram-negative bacilli. Vancomycin is essential for effective coverage against MRSA, while the third-generation cephalosporins like ceftazidime and cefepime, as well as meropenem, provide robust coverage against a broad spectrum of gram-negative organisms that could also be responsible for the infection. This combination not only addresses the immediate concern of acute bacterial meningitis but also ensures that a wide range of potential pathogens is adequately targeted. The severity and variety of bacteria present in this context necessitate such an aggressive and comprehensive approach, which is why this choice stands out as the best treatment option. Other treatment options either lack the broad-spectrum coverage required for the post-neurosurgical infection context or do not target the resistant organisms adequately.