Bacterial meningitis in children

National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. Mar 2024 [internet publication].Full text

van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62.Full text  Abstract

National Institute for Health and Care Excellence. Fever in under 5s: assessment and initial management. Nov 2021 [internet publication].Full text

1. Okike IO, Johnson AP, Henderson KL, et al. Incidence, etiology, and outcome of bacterial meningitis in infants aged <90 days in the United kingdom and Republic of Ireland: prospective, enhanced, national population-based surveillance. Clin Infect Dis. 2014 Nov 15;59(10):e150-7.Full text  Abstract

2. National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. Mar 2024 [internet publication].Full text

3. van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62.Full text  Abstract

4. Meningitis Research Foundation. Management of bacterial meningitis in infants <3 months. Nov 2017 [internet publication].Full text

5. Mace SE. Acute bacterial meningitis. Emerg Med Clin North Am. 2008 May;26(2):281-317. Abstract

6. Brouwer MC, van de Beek D. Epidemiology of community-acquired bacterial meningitis. Curr Opin Infect Dis. 2018 Feb;31(1):78-84. Abstract

7. Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol. 2015 Mar;42(1):29-45.Full text  Abstract

8. Hsu HE, Shutt KA, Moore MR, et al. Effect of pneumococcal conjugate vaccine on pneumococcal meningitis. N Engl J Med. 2009 Jan 15;360(3):244-56.Full text  Abstract

9. Castelblanco RL, Lee M, Hasbun R. Epidemiology of bacterial meningitis in the USA from 1997 to 2010: a population-based observational study. Lancet Infect Dis. 2014 Sep;14(9):813-9. Abstract

10. Centers for Disease Control and Prevention. Meningitis: resources for healthcare professionals. Aug 2019 [internet publication].Full text

11. Schuchat A, Robinson K, Wenger JD, et al. Bacterial meningitis in the United States in 1995. N Engl J Med. 1997 Oct 2;337(14):970-6.Full text  Abstract

12. Public Health England. Haemophilus influenzae: epidemiological data. Mar 2015 [internet publication].Full text

13. Koelman DLH, van Kassel MN, Bijlsma MW, et al. Changing epidemiology of bacterial meningitis since introduction of conjugate vaccines: 3 decades of national meningitis surveillance in The Netherlands. Clin Infect Dis. 2021 Sep 7;73(5):e1099-107.Full text  Abstract

14. Levy C, de La Rocque F, Cohen R. Epidemiology of pediatric bacterial meningitis in France. Med Mal Infect. 2009 Jul-Aug;39(7-8):419-31.Full text  Abstract

15. Public Health England. SMI B 27: investigation of cerebrospinal fluid. Jun 2017 [internet publication].Full text

16. World Health Organization. Meningitis. Sep 2021 [internet publication].Full text

17. Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. Abstract

18. Zwijnenburg PJ, van der Poll T, Roord JJ, et al. Chemotactic factors in cerebrospinal fluid during bacterial meningitis. Infect Immun. 2006 Mar;74(3):1445-51.Full text  Abstract

19. Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26;364(21):2016-25.Full text  Abstract

20. Tebruegge M, Curtis N. Epidemiology, etiology, pathogenesis, and diagnosis of recurrent bacterial meningitis. Clin Microbiol Rev. 2008 Jul;21(3):519-37.Full text  Abstract

21. Jallow S, Madhi SA. Pneumococcal conjugate vaccine in HIV-infected and HIV-exposed, uninfected children. Expert Rev Vaccines. 2017 May;16(5):453-65. Abstract

22. Chenou F, Azevedo J, Leal HF, et al. Bacterial meningitis in patients with sickle cell anemia in Salvador, Bahia, Brazil: a report on ten cases. Hematol Transfus Cell Ther. 2020 Apr - Jun;42(2):139-44.Full text  Abstract

23. Wilson-Clark SD, Squires S, Deeks S, et al. Bacterial meningitis among cochlear implant recipients - Canada, 2002. MMWR Suppl. 2006 Apr 28;55(1):20-4. Abstract

24. Furyk JS, Swann O, Molyneux E. Systematic review: neonatal meningitis in the developing world. Trop Med Int Health. 2011 Jun;16(6):672-9.Full text  Abstract

25. Centers for Disease Control and Prevention. Meningococcal disease in other countries. Feb 2024 [internet publication].Full text

26. Public Health England. Haemophilus influenzae: guidance, data and analysis. Apr 2013 [internet publication].Full text

27. National Institute for Health and Care Excellence. Fever in under 5s: assessment and initial management. Nov 2021 [internet publication].Full text

28. Henry BM, Roy J, Ramakrishnan PK, et al. Procalcitonin as a serum biomarker for differentiation of bacterial meningitis from viral meningitis in children: evidence from a meta-analysis. Clin Pediatr (Phila). 2016 Jul;55(8):749-64. Abstract

29. Bell JM, Shields MD, Agus A, et al. Clinical and cost-effectiveness of procalcitonin test for prodromal meningococcal disease: a meta-analysis. PLoS One. 2015;10(6):e0128993.Full text  Abstract

30. Wei TT, Hu ZD, Qin BD, et al. Diagnostic accuracy of procalcitonin in bacterial meningitis versus nonbacterial meningitis: a systematic review and meta-analysis. 2016 Mar;95(11):e3079.Full text  Abstract

31. Academy of Medical Royal Colleges. Statement on the initial antimicrobial treatment of sepsis. Oct 2022 [internet publication].Full text

32. National Institute for Health and Care Excellence. Suspected sepsis in under 16s: recognition, diagnosis and early management. Nov 2025 [internet publication].Full text

33. Randolph AG, McCulloh RJ. Pediatric sepsis: important considerations for diagnosing and managing severe infections in infants, children, and adolescents. Virulence. 2014 Jan 1;5(1):179-89.Full text  Abstract

34. Davis AL, Carcillo JA, Aneja RK, et al. American College of Critical Care Medicine clinical practice parameters for hemodynamic support of pediatric and neonatal septic shock. Crit Care Med. 2017 Jun;45(6):1061-93.Full text  Abstract

35. Daniels R, Nutbeam T, McNamara G, et al. The sepsis six and the severe sepsis resuscitation bundle: a prospective observational cohort study. Emerg Med J. 2011 Jun;28(6):507-12. Abstract

36. Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Pediatr Crit Care Med. 2020 Feb;21(2):e52-106.Full text  Abstract

37. Paul R, Neuman MI, Monuteaux MC, et al. Adherence to PALS sepsis guidelines and hospital length of stay. Pediatrics. 2012 Aug;130(2):e273-80. Abstract

38. Paul R, Melendez E, Stack A, et al. Improving adherence to PALS septic shock guidelines. Pediatrics. 2014 May;133(5):e1358-66. Abstract

39. Larsen GY, Mecham N, Greenberg R. An emergency department septic shock protocol and care guideline for children initiated at triage. Pediatrics. 2011 Jun;127(6):e1585-92. Abstract

40. Cruz AT, Perry AM, Williams EA, et al. Implementation of goal-directed therapy for children with suspected sepsis in the emergency department. Pediatrics. 2011 Mar;127(3):e758-66. Abstract

41. Chong SL, Ong GY, Venkataraman A, et al. The golden hours in paediatric septic shock--current updates and recommendations. Ann Acad Med Singap. 2014 May;43(5):267-74.Full text  Abstract

42. Romaine ST, Sefton G, Lim E, et al. Performance of seven different paediatric early warning scores to predict critical care admission in febrile children presenting to the emergency department: a retrospective cohort study. BMJ Open. 2021 May 4;11(5):e044091.Full text  Abstract

43. World Health Organization. Guideline: updates on paediatric emergency triage, assessment and treatment: care of critically-ill children. 2016 [internet publication].Full text

44. Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67.Full text  Abstract

45. Fleming S, Gill PJ, Van den Bruel A, et al. Capillary refill time in sick children: a clinical guide for general practice. Br J Gen Pract. 2016 Nov;66(652):587.Full text  Abstract

46. de Vos-Kerkhof E, Krecinic T, Vergouwe Y, et al. Comparison of peripheral and central capillary refill time in febrile children presenting to a paediatric emergency department and its utility in identifying children with serious bacterial infection. Arch Dis Child. 2017 Jan;102(1):17-21. Abstract

47. Wells LC, Smith JC, Weston VC, et al. The child with a non-blanching rash: how likely is meningococcal disease? Arch Dis Child. 2001 Sep;85(3):218-22.Full text  Abstract

48. Royal College of Paediatrics and Child Health. UK paediatric early warning systems (PEWS). Jul 2025 [internet publication].Full text

49. Tracy A, Waterfield T. How to use clinical signs of meningitis. Arch Dis Child Educ Pract Ed. 2020 Feb;105(1):46-9.Full text  Abstract

50. McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38.Full text  Abstract

51. Hasbun R, Abrahams J, Jekel J, et al. Computed tomography of the head before lumbar puncture in adults with suspected meningitis. N Engl J Med. 2001 Dec 13;345(24):1727-33.Full text  Abstract

52. Brouwer MC, Thwaites GE, Tunkel AR, et al. Dilemmas in the diagnosis of acute community-acquired bacterial meningitis. Lancet. 2012 Nov 10;380(9854):1684-92. Abstract

53. Vanopdenbosch LJ, Dedeken P, Casselman JW, et al. MRI with intrathecal gadolinium to detect a CSF leak: a prospective open-label cohort study. J Neurol Neurosurg Psychiatry. 2011 Apr;82(4):456-8. Abstract

54. Caltabiano GA, Viglianesi A, Bellomia D, et al. Spontaneous temporal cerebrospinal fluid leak. A case report and literature review. Neuroradiol J. 2010 Sep;23(4):420-5. Abstract

55. Weisfelt M, van de Beek D, Spanjaard L, et al. Clinical features, complications, and outcome in adults with pneumococcal meningitis: a prospective case series. Lancet Neurol. 2006 Feb;5(2):123-9. Abstract

56. Kneen R, Solomon T, Appleton R. The role of lumbar puncture in children with suspected central nervous system infection. BMC Pediatr. 2002 Sep 2;2:8.Full text  Abstract

57. Glimåker M, Johansson B, Bell M, et al. Early lumbar puncture in adult bacterial meningitis--rationale for revised guidelines. Scand J Infect Dis. 2013 Sep;45(9):657-63. Abstract

58. Proulx N, Fréchette D, Toye B, et al. Delays in the administration of antibiotics are associated with mortality from adult acute bacterial meningitis. QJM. 2005 Apr;98(4):291-8. Abstract

59. Michael BD, Sidhu M, Stoeter D, et al. Acute central nervous system infections in adults--a retrospective cohort study in the NHS North West region. QJM. 2010 Oct;103(10):749-58. Abstract

60. Vasilopoulou VA, Karanika M, Theodoridou K, et al. Prognostic factors related to sequelae in childhood bacterial meningitis: data from a Greek meningitis registry. BMC Infect Dis. 2011 Aug 10;11:214.Full text  Abstract

61. Snaebjarnardóttir K, Erlendsdóttir H, Reynisson IK, et al. Bacterial meningitis in children in Iceland, 1975-2010: a nationwide epidemiological study. Scand J Infect Dis. 2013 Nov;45(11):819-24. Abstract

62. Nigrovic LE, Kuppermann N, Malley R, et al. Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era. Acad Emerg Med. 2008 Jun;15(6):522-8.Full text  Abstract

63. Bargui F, D'Agostino I, Mariani-Kurkdjian P, et al. Factors influencing neurological outcome of children with bacterial meningitis at the emergency department. Eur J Pediatr. 2012 Sep;171(9):1365-71. Abstract

64. Namani S, Milenkovic Z, Kuchar E, et al. Mortality from bacterial meningitis in children in Kosovo. J Child Neurol. 2012 Jan;27(1):46-50. Abstract

65. Oostenbrink R, Moons KG, Donders AR, et al. Prediction of bacterial meningitis in children with meningeal signs: reduction of lumbar punctures. Acta Paediatr. 2001 Jun;90(6):611-7. Abstract

66. Centers for Disease Control and Prevention. Guideline for isolation precautions: preventing transmission of infectious agents in healthcare settings. Jul 2019 [internet publication].Full text

67. Public Health England. Meningococcal disease: guidance for public health management. Aug 2019 [internet publication].Full text

68. Hansson LO, Axelsson G, Linné T, et al. Serum C-reactive protein in the differential diagnosis of acute meningitis. Scand J Infect Dis. 1993;25(5):625-30. Abstract

69. Leen WG, Willemsen MA, Wevers RA, et al. Cerebrospinal fluid glucose and lactate: age-specific reference values and implications for clinical practice. PLoS One. 2012;7(8):e42745.Full text  Abstract

70. Tamune H, Takeya H, Suzuki W, et al. Cerebrospinal fluid/blood glucose ratio as an indicator for bacterial meningitis. Am J Emerg Med. 2014 Mar;32(3):263-6. Abstract

71. Brouwer MC, Tunkel AR, van de Beek D. Epidemiology, diagnosis, and antimicrobial treatment of acute bacterial meningitis. Clin Microbiol Rev. 2010 Jul;23(3):467-92.Full text  Abstract

72. Nigrovic LE, Malley R, Macias CG, et al. Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis. Pediatrics. 2008 Oct;122(4):726-30. Abstract

73. Ginsberg L, Kidd D. Chronic and recurrent meningitis. Pract Neurol. 2008 Dec;8(6):348-61. Abstract

74. Meningitis Research Foundation. Meningitis and sepsis symptoms. 2025 [internet publication].Full text

75. British Society for Antimicrobial Chemotherapy. Antimicrobial paediatric guide UK-PAS. Feb 2025 [internet publication].Full text

76. Public Health England. Listeria monocytogenes: surveillance reports. May 2025 [internet publication].Full text

77. National Institute for Health and Care Excellence. Neonatal infection: antibiotics for prevention and treatment. Mar 2024 [internet publication].Full text

78. National Institute for Health and Care Excellence. Intravenous fluid therapy in children and young people in hospital. Jun 2020 [internet publication].Full text

79. Resuscitation Council UK. Paediatric life support (basic and advanced). Oct 2025 [internet publication].Full text

80. Maitland K, Kiguli S, Opoka RO, et al. Mortality after fluid bolus in African children with severe infection. N Engl J Med. 2011 Jun 30;364(26):2483-95.Full text  Abstract

81. Li D, Li X, Cui W, et al. Liberal versus conservative fluid therapy in adults and children with sepsis or septic shock. Cochrane Database Syst Rev. 2018 Dec 10;12(12):CD010593.Full text  Abstract

82. Stephanie Smith S, ed. Advanced paediatric life support: a practical approach to emergencies, 7th ed. Hoboken, NJ: Wiley-Blackwell; 2023.

83. Royal College of Paediatrics and Child Care. Management of children and young people with an acute decrease in conscious level - clinical guideline. 2015 [internet publication].Full text

84. Melchers M, van Zanten ARH. Management of hypocalcaemia in the critically ill. Curr Opin Crit Care. 2023 Aug 1;29(4):330-8.Full text  Abstract

85. National Institute for Health and Care Excellence. Tuberculosis. Sep 2019 [internet publication].Full text

86. Public Health England. Listeriosis in England and Wales: summary for 2024. Mar 2025 [internet publication].Full text

87. Meningitis Research Foundation. Management of meningococcal disease in children and young people. Sep 2018 [internet publication].Full text

88. Carreras-Abad C, Cochet M, Hall T, et al. Developing a serocorrelate of protection against invasive group B streptococcus disease in pregnant women: a feasibility study. Health Technol Assess. 2019 Dec;23(67):1-40.Full text  Abstract

89. Baraff LJ, Lee SI, Schriger DL. Outcomes of bacterial meningitis in children: a meta-analysis. Pediatr Infect Dis J. 1993 May;12(5):389-94. Abstract

90. Grimwood K, Anderson VA, Bond L, et al. Adverse outcomes of bacterial meningitis in school-age survivors. Pediatrics. 1995 May;95(5):646-56. Abstract

91. Koomen I, Grobbee DE, Roord JJ, et al. Hearing loss at school age in survivors of bacterial meningitis: assessment, incidence, and prediction. Pediatrics. 2003 Nov;112(5):1049-53. Abstract

92. Edmond K, Dieye Y, Griffiths UK, et al. Prospective cohort study of disabling sequelae and quality of life in children with bacterial meningitis in urban Senegal. Pediatr Infect Dis J. 2010 Nov;29(11):1023-9. Abstract

93. Koomen I, Grobbee DE, Roord JJ, et al. Prediction of academic and behavioural limitations in school-age survivors of bacterial meningitis. Acta Paediatr. 2004 Oct;93(10):1378-85. Abstract

94. King BA, Richmond P. Pneumococcal meningitis in Western Australian children: epidemiology, microbiology and outcome. J Paediatr Child Health. 2004 Nov;40(11):611-5. Abstract

95. Ispahani P, Slack RC, Donald FE, et al. Twenty year surveillance of invasive pneumococcal disease in Nottingham: serogroups responsible and implications for immunisation. Arch Dis Child. 2004 Aug;89(8):757-62.Full text  Abstract

96. Zainel A, Mitchell H, Sadarangani M. Bacterial meningitis in children: neurological complications, associated risk factors, and prevention. Microorganisms. 2021 Mar 5;9(3):535.Full text  Abstract

97. Namani S, Milenković Z, Koci B. A prospective study of risk factors for neurological complications in childhood bacterial meningitis. J Pediatr (Rio J). 2013 May-Jun;89(3):256-62.Full text  Abstract

98. McCormick DW, Wilson ML, Mankhambo L, et al. Risk factors for death and severe sequelae in Malawian children with bacterial meningitis, 1997-2010. Pediatr Infect Dis J. 2013 Feb;32(2):e54-61.Full text  Abstract

99. Teixeira DC, Diniz LMO, Guimarães NS, et al. Risk factors associated with the outcomes of pediatric bacterial meningitis: a systematic review. J Pediatr (Rio J). 2020 Mar - Apr;96(2):159-67.Full text  Abstract

100. Pelkonen T, Roine I, Monteiro L, et al. Risk factors for death and severe neurological sequelae in childhood bacterial meningitis in sub-Saharan Africa. Clin Infect Dis. 2009 Apr 15;48(8):1107-10.Full text  Abstract

101. Chávez-Bueno S, McCracken GH Jr. Bacterial meningitis in children. Pediatr Clin North Am. 2005 Jun;52(3):795-vii. Abstract

102. Geiseler PJ, Nelson KE, Levin S, et al. Community-acquired purulent meningitis: a review of 1,316 cases during the antibiotic era, 1954-1976. Rev Infect Dis. 1980 Sep-Oct;2(5):725-45. Abstract

103. Brooks R, Woods CW, Benjamin DK Jr, et al. Increased case-fatality rate associated with outbreaks of Neisseria meningitidis infection, compared with sporadic meningococcal disease, in the United States, 1994-2002. Clin Infect Dis. 2006 Jul 1;43(1):49-54.Full text  Abstract

104. Beebeejaun K, Parikh SR, Campbell H, et al. Invasive meningococcal disease: timing and cause of death in England, 2008-2015. J Infect. 2020 Mar;80(3):286-90. Abstract

105. Zasowski EJ, Bassetti M, Blasi F, et al. A systematic review of the effect of delayed appropriate antibiotic treatment on the outcomes of patients with severe bacterial infections. Chest. 2020 Sep;158(3):929-38.Full text  Abstract

106. Kornelisse RF, Westerbeek CM, Spoor AB, et al. Pneumococcal meningitis in children: prognostic indicators and outcome. Clin Infect Dis. 1995 Dec;21(6):1390-7. Abstract

107. Chandran A, Herbert H, Misurski D, et al. Long-term sequelae of childhood bacterial meningitis: an underappreciated problem. Pediatr Infect Dis J. 2011 Jan;30(1):3-6. Abstract

108. Olarte L, Barson WJ, Barson RM, et al. Impact of the 13-Valent pneumococcal conjugate vaccine on pneumococcal meningitis in US children. Clin Infect Dis. 2015 Sep 1;61(5):767-75.Full text  Abstract

109. Bigler D, Burke K, Laureano N, et al. Assessment and treatment of behavioral disorders in children with hearing loss: a systematic review. Otolaryngol Head Neck Surg. 2019 Jan;160(1):36-48.Full text  Abstract

110. Karakoc K, Mujdeci B. Evaluation of balance in children with sensorineural hearing loss according to age. Am J Otolaryngol. 2021 Jan - Feb;42(1):102830. Abstract

111. Namani SA, Koci BM, Milenković Z, et al. Early neurologic complications and long-term sequelae of childhood bacterial meningitis in a limited-resource country (Kosovo). Childs Nerv Syst. 2013 Feb;29(2):275-80. Abstract

112. Snedeker JD, Kaplan SL, Dodge PR, et al. Subdural effusion and its relationship with neurologic sequelae of bacterial meningitis in infancy: a prospective study. Pediatrics. 1990 Aug;86(2):163-70. Abstract