Bacterial meningitis in children

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

INITIAL

suspected bacterial meningitis: presenting in hospital

<1 month of age

1st line – empirical antibiotics

Back

1st line –

empirical antibiotics

Without delay, give infants aged <1 month with suspected bacterial meningitis acquired in the community:[75]

Intravenous cefotaxime or ceftriaxone plus intravenous amoxicillin
Amoxicillin is used to cover Listeria monocytogenes, which is rare in the UK.[86] Therefore, amoxicillin is not commonly used in UK practice for suspected bacterial meningitis, unless the patient has specific risk factors for listeria meningitis. These risk factors include the neonatal period (age <28 days), pregnancy, immune compromise, and older age (>65 years).

Do not give ceftriaxone to premature babies or babies receiving calcium-containing infusions (use cefotaxime).[32] Ceftriaxone should also be avoided in babies with jaundice and any of the following: bilirubin level ≥200 umol/L, hypoalbuminaemia, or acidosis.

Give intravenous amoxicillin plus cefotaxime to babies in the neonatal unit with suspected meningitis and unknown causative pathogen.[77]

Have a low threshold for adding intravenous aciclovir to cover for herpes simplex virus (HSV) infection in infants age <1 month with suspected central nervous system infection or sepsis. Features that can suggest HSV infection include:[75]

ALT or AST >2x the upper limit of normal (ULN)
Coagulopathy
Vesicles
Seizures
CSF pleocytosis
Suspected meningitis/encephalitis
Recent maternal herpes simplex disease
Postnatal contact with herpes simplex virus

Get microbiologist or infectious diseases specialist advice for all cases of bacterial meningitis.[2]

If the child has an allergy to the recommended antibiotic or they are immunocompromised, follow your local protocols for appropriate alternatives and consult an infectious disease or microbiology specialist.

Primary options

cefotaxime: consult specialist for guidance on neonatal dose

ceftriaxone: consult specialist for guidance on neonatal dose

-- AND --

amoxicillin: consult specialist for guidance on neonatal dose

Plus – supportive care

Back

Plus –

supportive care

Treatment recommended for ALL patients in selected patient group

Escalate early. Initial assessment should be carried out by a senior clinical decision-maker (paediatric or emergency care qualified doctor, or equivalent with core competencies in the care of acutely ill children, e.g., ST4 level doctor or above in the UK).[2] If you suspect bacterial meningitis, consult a consultant/senior doctor in emergency medicine, paediatrics, anaesthesia, or intensive care if you suspect meningococcal sepsis and the child does not respond within 1 hour of any intervention.[32][87] See Meningococcal disease.

If the patient needs resuscitation, discuss with a paediatric intensivist as soon as possible.

Fluid resuscitation

Assess children and young people with suspected bacterial meningitis for all of the following:[2][31][44]

Signs of shock
Raised intracranial pressure
Signs of dehydration

If the patient shows signs of raised shock or raised intracranial pressure, start emergency management for these conditions. See Shock and Raised intracranial pressure below.

Correct dehydration (if present) in children and young people with suspected bacterial meningitis using enteral fluids or feeds, or intravenous isotonic fluids.[2][32] Follow your local protocols.

Do not routinely restrict fluids to below routine maintenance needs.
Give maintenance fluid enterally if tolerated, orally or by enteral tube.
Monitor fluid administration and urine output to ensure adequate hydration and avoid overhydration.[78]
Monitor electrolytes and blood glucose regularly (at least daily, while receiving intravenous fluids).[78]

Respiratory support

Give oxygen to children with suspected bacterial meningitis who have signs of shock or oxygen saturation (SpO₂) of less than 92% when breathing air.[32]

Ensure that appropriate respiratory support is provided for patients with respiratory compromise. Consult a consultant/senior doctor in emergency medicine, paediatrics, anaesthesia, or intensive care if a patient with meningitis has persistent hypoxia, respiratory distress, or inadequate ventilation, or if a patient requiring respiratory support does not respond within 1 hour.[31][32]

Tracheal intubation should only be undertaken by health professionals with expertise in paediatric airway management.

Shock

If there are signs of shock, give an immediate intravenous fluid bolus of isotonic crystalloid (such as sodium chloride 0.9%, Plasma-Lyte®, or Hartmann's solution [lactated Ringer's solution]), over 5-10 minutes.[32] The Resuscitation Council UK recommends using 10 mL/kg as a fluid bolus.[79] Give the fluid intravenously or via an intraosseous route and reassess the patient immediately afterwards.[79]

Seek immediate support from a consultant in emergency medicine, paediatrics, anaesthesia, or intensive care.

If signs of shock persist, give further fluid boluses of intravenous crystalloid over 5-10 minutes. Continue to reassess the patient after each fluid bolus to assess for clinical response and signs of fluid overload.[78]

If signs of shock (e.g., hypotension) still persist after 40-60 mL/kg of fluid resuscitation:[78]

Seek urgent expert advice (e.g., from the paediatric intensive care team)[78]

Vasoactive agents should be initiated early, and following the advice from a paediatric intensivist or experienced members of the critical care team.[44]
- If the patient does not respond to vasoactive agents, corticosteroid replacement therapy using low-dose corticosteroids may be used, but only when directed by a paediatric intensivist.[44] Local or national protocols should be followed.
Consider giving further fluid boluses under senior guidance, based on clinical signs and laboratory investigations (such as blood gases).

Seizures

Follow local or national protocols to treat seizures in children and young people with suspected bacterial meningitis.[82] See Generalised seizures in children.

Raised intracranial pressure

Follow local or national protocols to treat raised intracranial pressure.[82][83]

Plus – infection control

Back

Plus –

infection control

Treatment recommended for ALL patients in selected patient group

Isolate all patients with suspected meningitis until meningococcal meningitis is excluded (or considered unlikely) or empirical antibiotics have been given for 24 hours.[16][66] Always follow your local protocols, which may vary in practice.

Take droplet precautions, including wearing a surgical mask, if likely to be in close contact with respiratory secretions or droplets, until the patient has had 24 hours of antibiotics.[66][67]

Practical tip

Suspected meningitis is one of the commonest occupational exposures for healthcare workers but healthcare-associated infection is extremely rare.

Urgently notify the relevant public health authority and microbiology if you have a patient with suspected meningitis (regardless of the aetiology).[2]

In the UK, the doctor who suspects a diagnosis of meningitis has a legal duty to notify the case to the local health protection team or the on-call Public Health Specialist. This is usually done by the hospital doctor, but general practitioners may wish to check that it has been done. National Archives (UK): The Health Protection (Notification) Regulations 2010 Opens in new window

Plus – reassess and monitor

Back

Plus –

reassess and monitor

Treatment recommended for ALL patients in selected patient group

Measure and record the following at least every hour, in line with local protocols and/or your institution’s recommended early warning or risk stratification system:[31][48]

Heart rate
Respiratory rate and extent of respiratory distress
Oxygen saturations
Blood pressure
Temperature
Perfusion (capillary refill)
Neurological assessment (such as the Alert, Voice, Pain, Unresponsive [AVPU] scale)

Be aware that children and young people with bacterial meningitis (particularly meningococcal meningitis) can deteriorate rapidly regardless of the results of any initial assessment of severity. See Meningococcal disease.

Discuss any child or young person who needs resuscitation with a paediatric intensivist as soon as possible.

Be alert for metabolic disturbances such as hypoglycaemia and electrolyte abnormalities in children and young people with suspected or confirmed meningitis, which may indicate more severe disease (e.g., sepsis or septic shock). Manage according to local or national protocols.

Hyperglycaemia is common as part of the stress response to severe sepsis. It can also occur as a side effect of corticosteroid treatment.
Hypoglycaemia may occur as a result of depleted glycogen stores. Even brief episodes of severe hypoglycaemia during septic shock may be a risk factor for poor developmental outcomes in children.[44]
Hypocalcaemia is common in patients requiring intensive care unit admission for severe sepsis or septic shock.[84]

1 month to 15 years of age

1st line – empirical antibiotics

Back

1st line –

empirical antibiotics

Give children and young people aged 1 month to 15 years with suspected bacterial meningitis intravenous ceftriaxone without delay.[2] [ ]

Do not give ceftriaxone if giving calcium-containing infusions (use cefotaxime).[2]

Get microbiologist or infectious diseases specialist advice for all cases of bacterial meningitis.[2]

Primary options

ceftriaxone: children ≥1 month to 11 years of age and <50 kg body weight: 100 mg/kg intravenously every 24 hours, maximum 4 g/day; children 9-11 years of age and ≥50 kg body weight and children ≥12 years of age and adults: 2 g intravenously every 12 hours, or 4 g intravenously every 24 hours

cefotaxime: children ≥1 month of age: 50 mg/kg intravenously every 6 hours, maximum 12 g/day

Plus – supportive care

Back

Plus –

supportive care

Treatment recommended for ALL patients in selected patient group

If the patient needs resuscitation, discuss with a paediatric intensivist as soon as possible.

Fluid resuscitation

Assess children and young people with suspected bacterial meningitis for all of the following:[2][31][44]

Signs of shock
Raised intracranial pressure
Signs of dehydration

If the patient shows signs of raised shock or raised intracranial pressure, start emergency management for these conditions. See Shock and Raised intracranial pressure below.

Correct dehydration (if present) in children and young people with suspected bacterial meningitis using enteral fluids or feeds, or intravenous isotonic fluids.[2][32] Follow your local protocols.

Do not routinely restrict fluids to below routine maintenance needs.
Give maintenance fluid enterally if tolerated, orally or by enteral tube.
Monitor fluid administration and urine output to ensure adequate hydration and avoid overhydration.[78]
Monitor electrolytes and blood glucose regularly (at least daily, while receiving intravenous fluids).[78]

Respiratory support

Give oxygen to children with suspected bacterial meningitis who have signs of shock or oxygen saturation (SpO₂) of less than 92% when breathing air.[32]

Tracheal intubation should only be undertaken by health professionals with expertise in paediatric airway management.

Shock

Seek immediate support from a consultant in emergency medicine, paediatrics, anaesthesia, or intensive care.

If signs of shock (e.g., hypotension) still persist after 40-60 mL/kg of fluid resuscitation:[78]

Seek urgent expert advice (e.g., from the paediatric intensive care team)[78]

Vasoactive agents should be initiated early, and following the advice from a paediatric intensivist or experienced members of the critical care team.[44]
- If the patient does not respond to vasoactive agents, corticosteroid replacement therapy using low-dose corticosteroids may be used, but only when directed by a paediatric intensivist.[44] Local or national protocols should be followed.
Consider giving further fluid boluses under senior guidance, based on clinical signs and laboratory investigations (such as blood gases).

Seizures

Follow local or national protocols to treat seizures in children and young people with suspected bacterial meningitis.[82] See Generalised seizures in children.

Raised intracranial pressure

Follow local or national protocols to treat raised intracranial pressure.[82][83]

Consider – corticosteroid

Back

Consider –

corticosteroid

Additional treatment recommended for SOME patients in selected patient group

Give intravenous dexamethasone to children ≥3 months of age with strongly suspected or confirmed bacterial meningitis.[2] [ ]

Get infection specialist advice on using dexamethasone for babies between 28 days and 3 months old with strongly suspected or confirmed bacterial meningitis.[2] The first dose of dexamethasone, if indicated, should be given before or at the same time as antibiotics if possible.[2]

However, do not delay antibiotics to wait for dexamethasone to be started. In practice antibiotics are often given prior to dexamethasone due to the time taken for the initial CSF results to be made available.
- If dexamethasone is delayed for less than 12 hours after the start of antibiotics, give dexamethasone as soon as possible.
- If dexamethasone is delayed for more than 12 hours after the start of antibiotics, get advice from an infection specialist and decide whether dexamethasone is still likely to provide benefit.

When the causative organism is found:[2]

Continue dexamethasone if it is pneumococcus or Haemophilus influenzae type b
Stop dexamethasone for all other organisms

If no causative organism is found, get advice from an infection specialist on whether or not to continue dexamethasone.[2]

If tuberculous meningitis is a possible diagnosis, refer to your local guideline for advice before giving corticosteroids. In these patients, corticosteroids may be harmful if given without antituberculous therapy.[85] See Extrapulmonary tuberculosis.

Do not routinely give corticosteroids to children or young people with meningococcal disease.[2] See Meningococcal disease.

Primary options

dexamethasone: children ≥3 months of age: 150 micrograms/kg intravenously every 6 hours, maximum 10 mg/dose

Plus – infection control

Back

Plus –

infection control

Treatment recommended for ALL patients in selected patient group

Take droplet precautions, including wearing a surgical mask, if likely to be in close contact with respiratory secretions or droplets, until the patient has had 24 hours of antibiotics.[66][67]

Practical tip

Suspected meningitis is one of the commonest occupational exposures for healthcare workers but healthcare-associated infection is extremely rare.

Urgently notify the relevant public health authority and microbiology if you have a patient with suspected meningitis (regardless of the aetiology).[2]

In the UK, the doctor who suspects a diagnosis of meningitis has a legal duty to notify the case to the local health protection team or the on-call Public Health Specialist. This is usually done by the hospital doctor, but general practitioners may wish to check that it has been done. National Archives (UK): The Health Protection (Notification) Regulations 2010 Opens in new window

Plus – reassess and monitor

Back

Plus –

reassess and monitor

Treatment recommended for ALL patients in selected patient group

Measure and record the following at least every hour, in line with local protocols and/or your institution’s recommended early warning or risk stratification system:[31][48]

Heart rate
Respiratory rate and extent of respiratory distress
Oxygen saturations
Blood pressure
Temperature
Perfusion (capillary refill)
Neurological assessment (such as the Alert, Voice, Pain, Unresponsive [AVPU] scale)

Discuss any child or young person who needs resuscitation with a paediatric intensivist as soon as possible.

Hyperglycaemia is common as part of the stress response to severe sepsis. It can also occur as a side effect of corticosteroid treatment.
Hypoglycaemia may occur as a result of depleted glycogen stores. Even brief episodes of severe hypoglycaemia during septic shock may be a risk factor for poor developmental outcomes in children.[44]
Hypocalcaemia is common in patients requiring intensive care unit admission for severe sepsis or septic shock.[84]

suspected bacterial meningitis: presenting in the community

1st line – emergency transfer to hospital

Back

1st line –

emergency transfer to hospital

Arrange urgent transfer by blue-light ambulance for children and young people with suspected bacterial meningitis.[2][32]

In practice, where possible, the patient should arrive at hospital within 1 hour of being assessed in the community.

Tell the hospital that a patient with suspected bacterial meningitis or meningococcal disease is being transferred and that they will need assessment by a senior clinical decision-maker.[2]

Do not delay transfer to hospital to give antibiotics.[2][71]

If oxygen and pulse oximetry are available, administer oxygen to patients with suspected bacterial meningitis who have signs of shock or oxygen saturation (SpO₂) of less than 92% when breathing air.[32]

Safety netting

If your initial assessment rules out any suspicion of bacterial meningitis and you decide the patient can be managed in the community, ensure you give thorough safety netting advice.[2][74]

Encourage the parent/patient to trust their instincts and seek medical help again if the illness gets worse, even if this is shortly after the patient was seen.
Give advice on accessing further health care and ensure the parent/patient understands how to get medical help after normal working hours.
Provide information on symptoms of serious illness, including how to identify a non-blanching rash and the tumbler test.

Suggest follow-up within a specified period if you consider this to be appropriate. Use your clinical judgement.

Plus – infection control

Back

Plus –

infection control

Treatment recommended for ALL patients in selected patient group

Take droplet precautions, including wearing a surgical mask, if likely to be in close contact with respiratory secretions or droplets, until the patient has had 24 hours of antibiotics.[66][67]

Practical tip

Suspected meningitis is one of the commonest occupational exposures for healthcare workers but healthcare-associated infection is extremely rare.

Urgently notify the relevant public health authority and microbiology if you have a patient with suspected meningitis (regardless of the aetiology).[2]

In the UK, the doctor who suspects a diagnosis of meningitis has a legal duty to notify the case to the local health protection team or the on-call Public Health Specialist. This is usually done by the hospital doctor, but general practitioners may wish to check that it has been done. National Archives (UK): The Health Protection (Notification) Regulations 2010 Opens in new window

Consider – empirical antibiotics

Back

Consider –

empirical antibiotics

Additional treatment recommended for SOME patients in selected patient group

Give parenteral empirical antibiotics (intramuscular or intravenous ceftriaxone or benzylpenicillin) in the following cases:[2]

Strongly suspected bacterial meningitis if there is likely to be a significant delay of more than 1 hour in transfer to hospital.
Strongly suspected meningococcal disease, provided that this will not delay transfer to hospital. See Meningococcal disease.

Do not delay transfer to hospital to give antibiotics to people with suspected or strongly suspected bacterial meningitis or meningococcal disease.

Do not give antibiotics to patients with a history of severe allergy (e.g., anaphylaxis) to penicillins or cephalosporins; wait until admission to hospital.[2]

Primary options

benzylpenicillin sodium: children 1-11 months of age: 300 mg intravenously/intramuscularly as a single dose; children 1-9 years of age: 600 mg intravenously/intramuscularly as a single dose; children ≥10 years of age: 1200 mg intravenously/intramuscularly as a single dose

ceftriaxone: children 1 month of age: 250 mg intramuscularly as a single dose; children 2-11 months: 500 mg intramuscularly as a single dose; children 1-4 years of age: 1 g intramuscularly as a single dose; children 5-8 years of age: 1.5 g intramuscularly as a single dose; children ≥9 years of age and adults: 2 g intramuscularly as a single dose

ACUTE

confirmed or probable bacterial meningitis

1st line – pathogen-targeted antibiotics

Back

1st line –

pathogen-targeted antibiotics

Tailor the antibiotics according to the microbiological results, as well as discussion with microbiology and/or the multidisciplinary team where needed.

Get microbiologist or infectious diseases specialist advice for all cases of bacterial meningitis.[2]

Treat N meningitidis meningitis with high-dose intravenous ceftriaxone for 5 days in total unless directed otherwise by the results of antibiotic sensitivities. See Meningococcal disease.

If the patient has not recovered after 5 days, get microbiologist or infectious diseases specialist advice.
Do not give ceftriaxone to premature babies or children receiving calcium-containing infusions.[2][32] If ceftriaxone is contraindicated, consider cefotaxime.[2]
Seek advice from an infectious disease or microbiology specialist for infants with bacterial meningitis due to N meningitidis. N meningitidis may account for a smaller proportion of bacterial meningitis in this age group compared with older children, and this requires specialist management.[1][3]

Treat Streptococcus pneumoniae meningitis with high-dose intravenous ceftriaxone for 10 days in total unless directed otherwise by the results of antibiotic sensitivities.[2]

If the patient has not recovered after 10 days, get microbiologist or infectious diseases specialist advice.
Do not give ceftriaxone to premature babies or children receiving calcium-containing infusions.[2][32] If ceftriaxone is contraindicated, consider cefotaxime.[2]

Treat Haemophilus influenzae type b meningitis with high-dose intravenous ceftriaxone for 7-10 days unless directed otherwise by the results of antibiotic sensitivities.[2]

After 7 days, stop antibiotics if the patient has recovered, or continue for a total of 10 days if they have not. Get further advice from an infection specialist if the patient has not recovered after 10 days.
Do not give ceftriaxone to premature babies or children receiving calcium-containing infusions.[2][32] If ceftriaxone is contraindicated, consider cefotaxime.[2]

Treat group B streptococcal meningitis with high-dose intravenous ceftriaxone for 14 days, or as guided by culture sensitivities. Give intravenous benzylpenicillin plus gentamicin to babies with group B streptococcal meningitis in neonatal units.[75]

If the patient has not recovered after 14 days, get microbiologist or infectious diseases specialist advice.
Do not give ceftriaxone to premature babies or children receiving calcium-containing infusions.[2][32] If ceftriaxone is contraindicated, consider cefotaxime.[2]

Treat meningitis caused by Enterobacterales (coliforms) with high-dose intravenous ceftriaxone for 21 days unless directed otherwise by the results of antibiotic sensitivities.[2]

If the patient has not recovered after 21 days, get microbiologist or infectious diseases specialist advice.
Do not give ceftriaxone to premature babies or children receiving calcium-containing infusions.[2][32] If ceftriaxone is contraindicated, consider cefotaxime.[2]

Treat meningitis caused by Listeria monocytogenes with intravenous amoxicillin for 21 days unless directed otherwise by the results of antibiotic sensitivities.[2]

Get microbiologist or infectious diseases specialist advice on adding intravenous trimethoprim/sulfamethoxazole for the first 7 days
If the patient has not recovered after 21 days, get microbiologist or infectious diseases specialist advice.

Primary options

N meningitidis or S pneumoniae or H influenzae or group B streptococcus or Enterobacterales

ceftriaxone: neonates: consult specialist for guidance on dose; children ≥1 month to 11 years of age and <50 kg body weight: 100 mg/kg intravenously every 24 hours, maximum 4 g/day; children 9-11 years of age and ≥50 kg body weight and children ≥12 years of age and adults: 2 g intravenously every 12 hours, or 4 g intravenously every 24 hours

Group B streptococcus in neonatal unit

benzylpenicillin sodium: neonates: consult specialist for guidance on dose

and

gentamicin: neonates: consult specialist for guidance on dose

L monocytogenes

amoxicillin: neonates: consult specialist for guidance on dose; children ≥1 month of age: 50 mg/kg intravenously every 4-6 hours, maximum 2 g/dose

Secondary options

N meningitidis or S pneumoniae or H influenzae or group B streptococcus or Enterobacterales

cefotaxime: neonates: consult specialist for guidance on dose; children ≥1 month of age: 50 mg/kg intravenously every 6 hours, maximum 12 g/day

L monocytogenes

amoxicillin: neonates: consult specialist for guidance on dose; children ≥1 month of age: 50 mg/kg intravenously every 4-6 hours, maximum 2 g/dose

and

trimethoprim/sulfamethoxazole: children ≥6 weeks of age: 18-27 mg/kg intravenously every 12 hours, maximum 1.44 g/dose

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Show drug information for a patient with no comorbidities

Primary options

N meningitidis or S pneumoniae or H influenzae or group B streptococcus or Enterobacterales

ceftriaxone

Group B streptococcus in neonatal unit

benzylpenicillin sodium

and

gentamicin

L monocytogenes

amoxicillin

Secondary options

N meningitidis or S pneumoniae or H influenzae or group B streptococcus or Enterobacterales

cefotaxime

L monocytogenes

amoxicillin

and

trimethoprim/sulfamethoxazole

Plus – supportive care

Back

Plus –

supportive care

Treatment recommended for ALL patients in selected patient group

If the patient needs resuscitation, discuss with a paediatric intensivist as soon as possible.

Fluid resuscitation

Assess children and young people with suspected bacterial meningitis for all of the following:[2][31][44]

Signs of shock
Raised intracranial pressure
Signs of dehydration

If the patient shows signs of raised shock or raised intracranial pressure, start emergency management for these conditions. See Shock and Raised intracranial pressure below.

Correct dehydration (if present) in children and young people with suspected bacterial meningitis using enteral fluids or feeds, or intravenous isotonic fluids.[2][32] Follow your local protocols.

Do not routinely restrict fluids to below routine maintenance needs.
Give maintenance fluid enterally if tolerated, orally or by enteral tube.
Monitor fluid administration and urine output to ensure adequate hydration and avoid overhydration.[78]
Monitor electrolytes and blood glucose regularly (at least daily, while receiving intravenous fluids).[78]

Respiratory support

Give oxygen to children with suspected bacterial meningitis who have signs of shock or oxygen saturation (SpO₂) of less than 92% when breathing air.[32]

Tracheal intubation should only be undertaken by health professionals with expertise in paediatric airway management.

Shock

Seek immediate support from a consultant in emergency medicine, paediatrics, anaesthesia, or intensive care.

If signs of shock (e.g., hypotension) still persist after 40-60 mL/kg of fluid resuscitation:[78]

Seek urgent expert advice (e.g., from the paediatric intensive care team)[78]

Vasoactive agents should be initiated early, and following the advice from a paediatric intensivist or experienced members of the critical care team.[44]
- If the patient does not respond to vasoactive agents, corticosteroid replacement therapy using low-dose corticosteroids may be used, but only when directed by a paediatric intensivist.[44] Local or national protocols should be followed.
Consider giving further fluid boluses under senior guidance, based on clinical signs and laboratory investigations (such as blood gases).

Seizures

Follow local or national protocols to treat seizures in children and young people with suspected bacterial meningitis.[82] See Generalised seizures in children.

Raised intracranial pressure

Follow local or national protocols to treat raised intracranial pressure.[82][83]

Plus – reassess and monitor

Back

Plus –

reassess and monitor

Treatment recommended for ALL patients in selected patient group

Measure and record the following at least every hour, in line with local protocols and/or your institution’s recommended early warning or risk stratification system:[31][48]

Heart rate
Respiratory rate and extent of respiratory distress
Oxygen saturations
Blood pressure
Temperature
Perfusion (capillary refill)
Neurological assessment (such as the Alert, Voice, Pain, Unresponsive [AVPU] scale)

Discuss any child or young person who needs resuscitation with a paediatric intensivist as soon as possible.

Hyperglycaemia is common as part of the stress response to severe sepsis. It can also occur as a side effect of corticosteroid treatment.
Hypoglycaemia may occur as a result of depleted glycogen stores. Even brief episodes of severe hypoglycaemia during septic shock may be a risk factor for poor developmental outcomes in children.[44]
Hypocalcaemia is common in patients requiring intensive care unit admission for severe sepsis or septic shock.[84]

Use of this content is subject to our disclaimer

Bacterial meningitis in children

Treatment algorithm

suspected bacterial meningitis: presenting in hospital

<1 month of age

empirical antibiotics

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

supportive care

Fluid resuscitation

Respiratory support

Shock

Seizures

Raised intracranial pressure

infection control

Practical tip

reassess and monitor

1 month to 15 years of age

empirical antibiotics

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

supportive care

Fluid resuscitation

Respiratory support

Shock

Seizures

Raised intracranial pressure

corticosteroid

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

infection control

Practical tip

reassess and monitor

suspected bacterial meningitis: presenting in the community

emergency transfer to hospital

Safety netting

infection control

Practical tip

empirical antibiotics

Primary options

These drug options and doses relate to a patient with no comorbidities.

Primary options

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

confirmed or probable bacterial meningitis

pathogen-targeted antibiotics

Primary options

N meningitidis or S pneumoniae or H influenzae or group B streptococcus or Enterobacterales

Group B streptococcus in neonatal unit

L monocytogenes

Secondary options

N meningitidis or S pneumoniae or H influenzae or group B streptococcus or Enterobacterales

L monocytogenes

These drug options and doses relate to a patient with no comorbidities.

Primary options

N meningitidis or S pneumoniae or H influenzae or group B streptococcus or Enterobacterales

Group B streptococcus in neonatal unit

L monocytogenes

Secondary options

N meningitidis or S pneumoniae or H influenzae or group B streptococcus or Enterobacterales

L monocytogenes

Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.

Primary options

N meningitidis or S pneumoniae or H influenzae or group B streptococcus or Enterobacterales

Group B streptococcus in neonatal unit

L monocytogenes

Secondary options

N meningitidis or S pneumoniae or H influenzae or group B streptococcus or Enterobacterales

L monocytogenes

supportive care

Fluid resuscitation

Respiratory support