Antibiotics for unconfirmed meningitis (viral PCR negative): IV cefotaxime + amoxicillin for 14 days

• Empirical antibiotics for infants under 90 days

Note: Giving amoxicillin to cover the possibility of listeria up to the age of 3 months in addition to a 3rd generation cephalosporin, conforms to current NICE guidelines. However, research increasingly challenges the need for this, showing that listeria infection in infants aged over 30 days is very rare. Future updates of NICE guidelines may be revised to reflect this

Ceftriaxone and cefotaxime are interchangeable. 

Contraindications to ceftriaxone: as per BNFc: 

• under 41weeks corrected gestational age
• Neonates over 41weeks corrected gestational age with:
  • jaundice
  • acidosis
  • hypoalbuminaemia
  • simultaneous administration of calcium-containing infusions (inc total parenteral nutrition containing calcium)

Consider ambulatory/home antibiotics in selected cases.

Follow up and long term management:

• Use MRF discharge checklist https://www.meningitis.org/healthcare-professionals/resources
• Before discharge: consider need for after care, discuss potential long-term effects with parents and arrange hearing test within 4 weeks of being fit enough to test.
• Refer severe or profoundly deaf children for cochlear implant assessment ASAP.
• Direct to support organisations such as Meningitis Research Foundation, Meningitis Now & GBS Support.
• Arrange paediatric review with results of hearing test 4-6 weeks after discharge from hospital.
• Consider all potential morbidities at discharge and offer referral.
• Inform GP and health visitor.
• Follow up until at least 2 years of age

Notify public health: see public health guidance for prophylaxis of household contacts

• UK Gov (2022) Meningococcal Disease: guidance, data and analysis. 
• UK Gov (2013). Haemophilus influenzae type b (Hib): recommendations for the prevention of secondary cases.

References:

Okike, I.O., et al. (2015) Empirical antibiotic cover for Listeria monocytogenes infection beyond the neonatal period: a time for change? Archives of Diseases in Childhood. 100(5): p. 423-5.

Okike, I.O., R.F. Lamont, and P.T. Heath (2013) Do we really need to worry about Listeria in newborn infants? Pediatric Infectious Disease Journal 32(4): p. 405-6. 5.

Malley, M., et al. (2016) Prescribing amoxicillin for babies up to 3 months of age: definitely time for change. Archives of Diseases in Childhood. 101(3): p 294.