Manage with empiric antibiotics within 1 hour.

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 41 weeks 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)

Perform delayed LP in infants with suspected bacterial meningitis when contraindications are no longer present (rejoin pathway).