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Bacterial Meningitis (Paediatric)
Bacterial meningitis remains a medical emergency with high morbidity and mortality. Classic triad of fever, neck stiffness, and photophobia is absent in up to 50%. In children, bulging fontanelle, high-pitched cry, and purpuric rash are key…
NICE NG240 Bacterial Meningitis
The pathway
1 · Clinical features
- Infants: high-pitched cry, bulging fontanelle, poor feeding
- Older children: neck stiffness, Kernig's/Brudzinski's, photophobia, purpuric rash.
2 · IV antibiotics immediately
Ceftriaxone 80mg/kg ONCE DAILY (max 4g in 24h) IV. Splitting the daily dose in two splits that total — it does not double it. Do NOT delay for LP if systemically unwell, purpuric rash, or GCS <15.
3 · Dexamethasone
0.15mg/kg IV QDS for 4 days — give BEFORE or with first antibiotic dose. Reduces hearing loss and neurological sequelae in H. influenzae and pneumococcal meningitis.
4 · LP decision
Perform LP if: GCS 15, no papilloedema, no focal neurology, no coagulopathy, no cardiovascular compromise. CT before LP only if focal neurology or papilloedema.
5 · Airway & monitoring
Monitor GCS and pupils hourly. Nurse at 30° head up. Avoid overhydration (cerebral oedema). Treat seizures per APLS protocol.
6 · Public health
Notify public health authority immediately. Close contacts require rifampicin or ciprofloxacin prophylaxis within 24h.
Drugs
| Drug | Dose | Route | Notes |
|---|---|---|---|
| Ceftriaxone | 80mg/kg (max 4g/day) | IV once daily | First-line for bacterial meningitis. Once daily — a daily dose over 2g may be split in two, which splits that total rather than doubling it. Continue 10–14 days; for Listeria add ampicillin. |
| Dexamethasone | 0.15mg/kg (max 10mg) | IV QDS | 4 days. Start before/with first antibiotic dose. Reduces hearing loss. |
| Ampicillin | 50mg/kg (max 2g) QDS | IV | Add if Listeria suspected — neonate or immunocompromised. |
| Mannitol 20% | 0.5–1g/kg | IV over 15–20 min | For signs of raised ICP — headache, bradycardia, Cushing's triad. |
When to escalate
Purpuric/petechial rash — meningococcal septicaemia, IM ceftriaxone immediately,GCS <12 or focal neurology — PICU, CT head, raised ICP management,Seizures — treat per APLS protocol, PICU if refractory,Notify public health (Consultant in Health Protection) — close contact prophylaxis within 24h
Reference: NICE NG240 Meningitis (bacterial) and meningococcal disease 2024 (replaced CG102) / APLS / UKHSA
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