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Bacterial meningitis in children
In bacterial meningitis time is the deciding factor: empirical antibiotics start at once, and if the lumbar puncture will be delayed or is contraindicated — take a blood culture and give antibiotics before the puncture.
Why it matters in the exam
Questions test the organisms by age (in the newborn GBS, E. coli and Listeria; after one month S. pneumoniae and N. meningitidis), the empirical treatment (ceftriaxone with vancomycin beyond the newborn period), the place of dexamethasone and the interpretation of the CSF. A common question: when not to do a lumbar puncture before treatment.
Another important part is prevention and complications. Close contacts of a meningococcal case receive prophylaxis (rifampin, ceftriaxone or ciprofloxacin) as early as possible, ideally within 24 hours. Complications that are asked about: SIADH, seizures, subdural effusion, hydrocephalus and deafness — so every child who recovers has a hearing test. A petechial or purpuric rash with fever suggests meningococcaemia and requires immediate antibiotics.
The clinical picture changes with age: in an infant the signs are non-specific — fever, irritability, poor feeding, a bulging fontanelle — and classic meningeal signs such as neck stiffness, Kernig and Brudzinski are rare. In an older child there is headache, vomiting, photophobia and neck stiffness. Hib and pneumococcal vaccines have greatly reduced the disease, so the vaccination status should be checked in every case.
Key points
- After one month: S. pneumoniae and N. meningitidis.
- Ceftriaxone + vancomycin; in the newborn ampicillin with cefotaxime or gentamicin.
- Bacterial: neutrophils, low glucose, high protein.
- Antibiotics are not delayed for a CT or a puncture.
- Close meningococcal contacts: prophylaxis within 24 hours; a hearing test for every survivor.
Summary table
| Issue | Bacterial | Viral |
|---|---|---|
| Organisms | Newborn: GBS, E. coli, Listeria; after one month: S. pneumoniae, N. meningitidis (Hib if unvaccinated) | Enteroviruses (summer-autumn), HSV, other herpesviruses |
| CSF cells | Usually above 1000, mostly neutrophils | Usually below 500, mostly lymphocytes |
| Glucose and protein | Glucose below 40 mg/dL (or a CSF-to-blood ratio below 0.4); high protein | Normal glucose; normal or slightly raised protein |
| Empirical treatment beyond the newborn period | Ceftriaxone + vancomycin; consider dexamethasone 0.15 mg/kg every 6 hours, given just before or with the first dose | Supportive; acyclovir if HSV is suspected |
| Contact prophylaxis (meningococcus) | Rifampin for two days, or a single dose of ceftriaxone, or a single dose of ciprofloxacin | — |
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Sources
- AAP Red Book: Report of the Committee on Infectious Diseases, 2024–2027 edition — Pneumococcal Infections; Meningococcal Infections; Haemophilus influenzae Infections
- NICE guideline NG240: Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management, 2024 — Diagnosis and treatment
- Nelson Textbook of Pediatrics, 22nd edition (2024) — Acute Bacterial Meningitis Beyond the Neonatal Period
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-02. The text may contain errors; when in doubt, check the source.