Meningitis suggested by LP results

NHS Tayside ED Guidance
NHS Tayside
  • Consider TB meningitis:  if raised CSF WCC and risk factors for TB. If TB meningitis in differential diagnosis, refer to NICE (2019) TB NG33 for appropriate antibiotic treatment. 
  • Consider herpes simplex meningoencephalitis: If HSV in differential diagnosis give Aciclovir.

Administer steroids if 12h or less from first antibiotics and LP shows:

  •  frankly purulent CSF
  • CSF WCC over 1000/μl
  • raised CSF WCC and protein above 1 g/L
  • bacteria on gram stain.
  • Steroids should not be used in developing countries. 
  • If TB meningitis in the differential diagnosis, refer to NICE (2019) TB NG33 before administering steroids.

Steroid dosage: dexamethasone 0.15 mg/kg to a max dose of 10 mg, qds x 4 days for children 3 months or older.

Note: Indications for tracheal intubation and mechanical ventilation:

  • Threatened or actual loss of airway patency (e.g. GCS <9, response to pain only).
  • Need for any form of assisted ventilation e.g. bag–mask ventilation.
  • Clinical observation of increased work of breathing
  • Hypoventilation or apnoea
  • Features of respiratory failure, including
    • irregular respiration (e.g. Cheyne–Stokes breathing)
    • hypoxia (saturation below 94% in air, PaO2 below 13 kPa or 97.5mmHg), hypercapnoea (PaCO2 over 6 kPa or 45 mmHg).
  • Continuing shock following 40ml/kg of resuscitation fluid
  • Signs of raised intracranial pressure
  • Impaired mental status
    • GCS drop of more than 3, or score below 9, or fluctuation in conscious level
    • moribund state
  • Control of intractable seizures
  • Need for Stabilisation for brain imaging or for transfer to PICU.

Should be undertaken by a health professional with expertise in paediatric airway management, consult PICU/. (See note MD4)

Does the patient have any of the following indications requiring CT scan?

Note: CT scan cannot reliably detect raised intracranial pressure. This should be assessed clinically.

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