Suspected Pediatric Bacterial Meningitis
Child with fever, altered mental status, meningeal signs
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PediatricsEmergency
Pediatric Bacterial Meningitis (IDSA/NICE)
Pediatric Bacterial Meningitis (IDSA/NICE): Suspected Pediatric Bacterial Meningitis → Recognition & Initial Stabilization → LP Contraindicated? → Perfo...
Pathway Overview
9 steps
Algorithm Steps
9 total
01Start 02Action Recognition & Initial Stabilization
Clinical features and immediate actions
- CLINICAL FEATURES:
- • Fever, headache, photophobia
- • Neck stiffness (may be absent in infants)
- • Altered mental status, lethargy, irritability
- • Bulging fontanelle (infants)
- • Petechial/purpuric rash (meningococcal)
- STABILIZE: ABCs, IV access, vitals
03Decision LP Contraindicated?
Can lumbar puncture be done safely?
- CONTRAINDICATIONS to LP:
- • Signs of raised ICP (papilledema, posturing)
- • GCS <10 or rapidly deteriorating
- • Focal neurologic signs
- • Coagulopathy (platelets <50K, INR >1.5)
- • Hemodynamic instability/shock
- • Skin infection at LP site
04Action Perform Lumbar Puncture
CSF analysis essential for diagnosis
- CSF STUDIES:
- • Cell count and differential
- • Glucose and protein
- • Gram stain and culture
- • Consider: PCR (bacterial, viral), latex agglutination
- BACTERIAL CSF typical:
- • WBC >1000 (neutrophil predominant)
- • Protein >100 mg/dL
- • Glucose <40 mg/dL or CSF:serum ratio <0.4
05Action Empiric Antibiotic Therapy
Age-based empiric coverage
- AGE >1 MONTH:
- • Ceftriaxone 100 mg/kg/day IV divided q12h (max 4g/day)
- • + Vancomycin 60 mg/kg/day IV divided q6h (for resistant S. pneumoniae)
- NEONATES (<1 month):
- • Ampicillin 200-300 mg/kg/day + Cefotaxime (or gentamicin)
- • Covers GBS, E. coli, Listeria
- Duration: 7-21 days depending on organism
06Action Dexamethasone
Give with or before first antibiotic dose
- DEXAMETHASONE 0.15 mg/kg IV q6h x 2-4 days
- Give BEFORE or WITH first antibiotic dose
- Most beneficial for H. influenzae and S. pneumoniae
- May reduce neurologic sequelae
- Contraindicated in neonates (debated)
07Action Supportive Care & Monitoring
ICU-level care often needed
- Monitor for complications:
- • Seizures (treat with lorazepam/levetiracetam)
- • Cerebral edema (consider mannitol/hypertonic saline)
- • SIADH (fluid restrict if hyponatremic)
- • DIC (if meningococcal)
- • Subdural effusion/empyema
- Serial neuro exams
- Repeat LP if not improving by 48-72 hours
08Outcome Follow-Up
Post-treatment care
- Hearing evaluation before discharge
- Neurodevelopmental follow-up
- Vaccination review
- Contact prophylaxis for N. meningitidis exposure
09Action Empiric Antibiotics IMMEDIATELY
Do NOT delay antibiotics for LP or imaging
- DO NOT DELAY ANTIBIOTICS!
- If LP contraindicated → give antibiotics first
- Get blood cultures before antibiotics if possible
- (but do not delay abx for cultures)
- Path rejoins step 05Shared downstream outcome
Guideline Source
IDSA Practice Guidelines for Bacterial Meningitis 2004 + NICE 2024
Clinical Safety Information
Clinical Decision Support — Not a Substitute for Clinical Judgment
Individual patient factors may require deviation from these recommendations.
Known Limitations
- Does not cover neonatal meningitis in detail
- Local resistance patterns may vary
- Does not address viral or fungal meningitis
Applicable Regions
USEU
Version 1Next review: 2027-01-11
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Related Resources
Frequently Asked Questions
What is the Pediatric Bacterial Meningitis (IDSA/NICE)?
The Pediatric Bacterial Meningitis (IDSA/NICE) is a emergency clinical algorithm for Pediatrics. It provides a structured decision tree to guide clinical decision-making, based on IDSA Practice Guidelines for Bacterial Meningitis 2004 + NICE 2024.
What guideline is the Pediatric Bacterial Meningitis (IDSA/NICE) based on?
This algorithm is based on IDSA Practice Guidelines for Bacterial Meningitis 2004 + NICE 2024 (DOI: 10.1093/cid/cih430).
What are the limitations of the Pediatric Bacterial Meningitis (IDSA/NICE)?
Known limitations include: Does not cover neonatal meningitis in detail; Local resistance patterns may vary; Does not address viral or fungal meningitis. Individual patient factors may require deviation from these recommendations.
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