Lumbar puncture

NHS Tayside ED Guidance
NHS Tayside

Perform lumbar puncture. Do not delay antibiotics - start within 1 hour of suspected meningitis.

CSF – MC&S, glucose, protein, Viral PCR (herpes, enterovirus, parechovirus) and bacterial PCR.

LP information leaflet available for parents.

Get CSF results promptly (aim for under 2 hours).

Empiric antibiotics for suspected meningitis:

  • i.v. cefotaxime and amoxicillin.
  • Can replace cefotaxime with ceftriaxone if no contraindication.
  • Consider i.v. meropenem in babies at high risk of multi-drug resistant gram negative infections (MDRGN) e.g. infants known to be colonised with MDRGN.
  • Consider adding Vancomycin if central line or VP shunt in situ.

Antibiotic doses:

  • Cefotaxime 50mg/kg under 7 days every 12hrs, 7-21 days every 8hrs, 21-28 days every 6-8hrs, over 1 month every 6hrs. Max 12g/day.
  • Amoxicillin 100mg/kg under 7 days every 12hrs, 7-28 days every 8hrs. Max 2g every 4hrs.
  • Vancomycin 15mg/kg, adjusted according to plasma concentration. Under 29 weeks corrected gestational age (CGA) every 24hrs, 29-34 weeks CGA every 12hrs, over 35 weeks CGA every 8hrs. Max 2g daily.
  • Meropenem 40mg/kg under 7 days every 12hrs, over 7 days every 8hrs.

Contraindications to Ceftriaxone: as per BNF for Children

  • under 41weeks corrected gestational age
  • Neonates over 41weeks corrected gestational age with:
    • jaundice 
    • acidosis 
    • hypo-albuminemia
  • Simultaneous administration of calcium-containing infusions (including total parenteral nutrition containing calcium)

Are lumbar puncture results available?

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