Paediatrics - Queensland Health - Queensland Government

Meningitis
• In the critically ill, shocked or septic child with suspected meningitis e.g.
unresponsive, poorly perfused, purpuric rash, it is appropriate to first give a bolus
of intravenous or intraosseous fluids (initially 10 - 20 mL / kg of normal saline [1])
before giving antibiotics. Otherwise restrict total fluids to 10 mL / kg.
• MO to consult as soon as possible with Paediatrician
3. Clinical assessment
• Obtain as complete a patient history as possible according to the circumstances
of the presentation. Of particular importance in a sick looking child is:
-- -headache, irritability, fever, ask about any rash, neck stiffness
• Perform standard clinical observations +
-- weight (if able)
-- GCS
-- O saturation
2
• Perform physical examination:
-- inspect all skin surfaces for any skin rash especially at pressure points and
under nappies and clothing. Note: petechiae and purpura do not fade on
pressure
-- assess hydration status
-- -inspect and palpate the ears, nose and throat
-- palpate the fontanelle in young baby - feeling for fullness
-- check for neck stiffness - with patient lying down, put hand behind head and
gently raise
-- auscultate the chest for air entry and any added sounds (crackles or wheezes)
• Check vaccination status, especially Hib / meningococcal / conjugate
pneumococcal
4. Management
• Consult MO who will arrange / order:
-- evacuation / hospitalisation
-- monitor clinical observations closely
-- continue IV / IO fluids at 50% of maintenance fluids (10 mL / kg). If the child is
drinking ensure total fluids do not exceed 10 mL / kg (or 50 % of maintenance
fluids)
-- if meningitis is suspected, stat dose of parenteral antibiotics must be given
before transfer to hospital. Blood samples for culture and PCR should be
taken where possible but should not delay initial treatment
-- give IV ceftriaxone (can be given by IM route if unable to obtain IV access)
100 mg / kg / dose to a total of 4 grams daily (or 50 mg / kg / dose bd to a total
of 2 grams bd) [3]
• Give paracetamol for fever, pain or distress
See Simple analgesia back cover
5. Follow up
All children with suspected meningitis should be managed in an appropriately
equipped hospital
Notify the Public Health Unit of any suspected case of bacterial meningitis as
soon as possible
Chemoprophylaxis will be required for close contacts of a patient with either
meningococcal or Hib meningitis. Unvaccinated contacts of Hib meningitis