Paediatric Meningitis

Last updated 20.09.12

 

Index

 

Description

-  Meningitis in the paediatric population

 

Features

-   

 

Causes

-  Bacterial Meningitis >2 months

-  Streptococcus pneumoniae

-  Neisseria meningitides

-  Haemophilus influenza type b

-   Uncommon >6yrs

-  <2 months

-  Streptococcus agalactiae (GBS)

-  E. Coli & other Gram negatives

-  Streptococcus pneumoniae

-  Neisseria meningitides

-  Listeria monocytogenes

-  Haemophilus influenza type b (Hib)

-  In presence of spinal abnormalities or VP shunts seek specialist advice

 

Risk Factors

-  Orbital cellulitis

-  Mastoiditis --> Gradenigo syndrome

 

Associated S/S

-  Infants usually non-specific

-  Fever, irritability, lethargy, poor feeding, vomiting

-  Bulging/full anterior fontanelle

-  +/- headache & photophobia

-  Usually in older children

-  Neck stiffness (unreliable in children)

-  Pupuric rash (meningococcal septicaemia)

-  Seizure

 

Ix

-  LP

-  Consider CT-Brain prior

-  FBE

-  CRP

-  U&E

-  BSL, venous glucose

-  BC

-  +/- CT-Brain if seizure or neurological defecit

-  To exclude IICP & prevent coning

 

Mx

-  Empirical Abx

-  Continue empirical Abx until cultures negative or organism + sensitivities known

-  >2 months

-   Cefotaxime 50mg/kg (max 2g) IV 6/24

-  4 weeks – 2 months

-   Cefotaxime 50mg/kg (max 2g) IV 6/24

-   BenzylPenicillin 60mg/kg IV 4/24

-   Gentamicin 4mg/kg IV Daily

-  <4 weeks

-   Cefotaxime 50mg/kg (max 2g) IV 6/24

-   BenzylPenicillin 60mg/kg IV

-  12/24 in 1st week of life

-  6-8/24 weeks 2-4

-   Gentamicin 4mg/kg IV Daily

-  Instead of Cefotaxime

-   Ceftriaxome 100mg/kg (max 2g) IV Daily

-   Chloramphenicol if immediate hypersensitivity to Cephalosporins

-  Organism Specific Mx

-  Streptococcus pneumoniae

-   BenzylPenicillin 50mg/kg (max 3g) IV 4/24 7 days+

-   If confirmed notify DHS (1300 651 160)

-  Neisseria meningitides

-   BenzylPenicillin 50mg/kg (max 3g) IV 4/24 10 days+

-   If presumed or confirmed notify DHS (1300 651 160)

-  Haemophilus influenza type b

-   Cefotaxime 50mg/kg (max 3g) IV 6/24 7-10 days

-   If confirmed notify DHS (1300 651 160)

-  No organism isolated + CSF pleocytosis: Cefotaxime 7 days

-  Steroids

-  Protect from neurological sequelae (esp deafness) +/- reduce mortality

-  Benefit greatest if given 15min+ before 1st dose Abx

-  If >4 weeks old Dexamethasone 0.15mg/kg IV 6/24 for 4 days

-  If <4 weeks nil steroids

-  Cease steroids prior to 4 days if ceasing Abx due to clear cultures

-  +/- Rifampacin for contact chemoprophylaxis

-  F/U 6-8 weeks w Audiology if confirmed case

 

 

 

References

 

RCH – CPG: Meningitis Guideline