Patient handout

Pediatric bacterial meningitis

PRODUCTION

1. Your condition

This handout is for pediatric bacterial meningitis. Your care team identified this based on: fever + neck stiffness / photophobia / headache in a child.

Other reasons your team may use this plan: ams / lethargy / irritability + fever in a child; bulging fontanelle in an infant; petechiae / purpura with fever (meningococcaemia concern).

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
ampicillin	75 mg/kg/dose IV q6-8h (meningitis dose)	IV	q6-8h	Listeria + GBS coverage (IDSA 2004 Tunkel)
cefotaxime	50-75 mg/kg/dose IV q6-8h	IV	q6-8h	Avoid ceftriaxone <1 mo (bilirubin / calcium-IVF concerns); cefotaxime preferred (IDSA 2004 Tunkel; AAP 2021)
gentamicin	4-5 mg/kg/dose IV q24-36h (gestational age dependent)	IV	q24-36h	Synergy with ampicillin for Listeria; alternative if cefotaxime unavailable (IDSA 2004 Tunkel)
acyclovir	20 mg/kg/dose IV q8h	IV	q8h	Cover HSV until excluded; high mortality if missed (AAP 2021)

Plan: Pediatric bacterial meningitis empirics — age-tiered + dexamethasone for Hib

3. When to call your provider

Contact your care team if any of the following happen:

New fever / chills / new headache or neck stiffness / fontanelle bulging in infant → ED for recurrent-meningitis workup (IDSA 2004 Tunkel; AAP Red Book)
New focal neurologic deficit / new seizure / worsening cognition → urgent peds-neurology + imaging (IDSA 2004 Tunkel; ESCMID 2016)
Subacute headache + nausea / vomiting / cognitive decline → suspect late-onset hydrocephalus → urgent imaging + peds-neurosurgery (ESCMID 2016)
Audiology demonstrates moderate-severe sensorineural hearing loss → ENT + hearing-aid / cochlear-implant evaluation (Cochrane Brouwer 2010; NICE NG240 2024)
Developmental regression on neurodev assessment → peds-developmental clinic + speech therapy + OT/PT + school accommodations (AAP Red Book)
PHQ-9-A ≥ 15 OR suicidal ideation in adolescent OR UCLA-PTSD-RI elevated in younger child → mental-health urgent referral
Caregiver PHQ-9 ≥ 15 OR PSS-FH elevated → caregiver mental-health referral + PICS-Family support
Close contact (meningococcal aetiology) develops fever / rash / headache → ED for immediate evaluation (CDC meningococcal guidelines; NICE NG240 2024)
Recurrent meningitis episode → admit + workup for predisposition (complement deficiency, anatomic CSF leak, dermal sinus, immunodeficiency) (IDSA 2004 Tunkel; AAP Red Book)

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

Petechial / purpuric rash with fever ± shock (suspected meningococcaemia)(life-threatening)
Cushing triad (HTN + bradycardia + irregular respirations), papilledema, fixed/dilated pupil, or rapid GCS decline(life-threatening)
Continuous or recurrent seizure ≥5 min in a child with suspected meningitis(life-threatening)
Hypotension / shock signs in pediatric meningitis(life-threatening)
Focal neurological deficit, AMS, papilledema, immunocompromise, recent seizure, or signs of raised ICP
Child <5 yr, incompletely vaccinated for Hib
Second episode in same patient
Pediatric bacterial meningitis + septic shock features (hypotension on age-adjusted thresholds + lactate ≥ 2 mmol/L + vasoactive requirement OR Phoenix cardiovascular sub-score ≥ 1; SSC peds 2020 Weiss PMID 32032273; Phoenix Schlapbach JAMA 2024 PMID 38245901) — most commonly Waterhouse-Friderichsen with meningococcus, but pneumococcal sepsis in immunocompromised host can present similarly(life-threatening)
Empiric dexamethasone + antibiotic NOT administered within ≤ 30-60 min of clinical suspicion of pediatric bacterial meningitis (≤ 30 min if suspected meningococcaemia per NICE NG240) OR LP delayed beyond 30 min when not contraindicated; ≥ 1 h mortality gradient stronger in peds per Kumar 2006 + Auburtin CCM 2006 PMID 16915106 + SSC peds 2020 Hour-1 bundle analog
Behaviourally explicit pediatric raised-ICP phenotype: fontanelle bulging in infant + bradycardia + HTN (Cushing reflex components) + abnormal / asymmetric pupils + GCS drop ≥ 2 points OR new posturing OR new seizure with elevated opening pressure OR paradoxical irritability in infant (IDSA 2004 Tunkel; ESCMID 2016; Glaser NEJM 2001 PMID 11172164 cerebral-edema risk-model analog)(life-threatening)
Nigrovic Bacterial Meningitis Score ≥ 1 (any of: positive CSF Gram stain OR CSF ANC ≥ 1000 cells/µL OR CSF protein ≥ 80 mg/dL OR peripheral ANC ≥ 10,000 cells/µL OR seizure at or before presentation) in alert child with CSF pleocytosis (Nigrovic JAMA 2007 PMID 17200475); high-risk → admit + empiric abx + LP-confirmed; BMS = 0 in alert child + reliable safety-net follow-up + viable viral aetiology (enterovirus PCR positive, summer epidemiology) = consider outpatient observation with 24-h re-check
Pediatric bacterial meningitis admission requires audiology screening before discharge (admit-discharge process gate) — sensorineural hearing loss rates ~30% pneumococcal, ~10-20% Hib, ~5-10% meningococcal in peds survivors (Cochrane Brouwer 2010 PMID 20824838; AAP Red Book; NICE NG240 2024); discharge without audiology = process failure
Focal neurologic deficit + persistent fever despite ≥ 48 h of appropriate empiric antibiotics OR new seizure or worsening AMS during treatment course → suspect subdural empyema, brain abscess, or ventriculitis (IDSA 2004 Tunkel; IDSA/AAN 2017 PMID 28203777; ESCMID 2016)(life-threatening)

5. Follow-up

Audiology assessment (Hib / pneumococcus); neurodevelopmental review; outpatient ID f/u; immunisation catch-up + chemoprophylaxis for close contacts (rifampin / ciprofloxacin / ceftriaxone for Nm; rifampin for Hib if indicated)

6. Sources

Guideline: IDSA 2004 Bacterial Meningitis (Tunkel) + IDSA 2024 community-acquired BM update (referenced; PMID pending) + IDSA/AAN 2017 healthcare-associated ventriculitis & meningitis + AAP Red Book current edition + Cochrane Brouwer 2010 corticosteroids in bacterial meningitis (de Gans / van de Beek) + ESCMID 2016 + NICE NG240 2024 + Nigrovic Bacterial Meningitis Score (JAMA 2007) + SSC peds 2020 (Weiss) for meningitis-with-shock overlap + PALS 2020/2024