Meningitis (peds): Difference between revisions
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*Neonates - IV [[ampicillin]] + [[gentamicin]] | *Neonates - IV [[ampicillin]] + [[gentamicin]] | ||
**If suspecting [[S. pneumoniae]], add [[vancomycin]] | **If suspecting [[S. pneumoniae]], add [[vancomycin]] | ||
**Empiric therapy for late-onset includes [[Penicillins|anti-staph agent]] plus [[ceftazidime]], [[amikacin]], or [[ | **Empiric therapy for late-onset includes [[Penicillins|anti-staph agent]] plus [[ceftazidime]], [[amikacin]], or [[meropenem]] | ||
**[[Ceftriaxone]] may cause bilirubin encephalopathy in neonates | **[[Ceftriaxone]] may cause bilirubin encephalopathy in neonates | ||
*Infants and children - [[Vancomycin]] 60 mg/kg/d q6h plus [[Ceftriaxone]] 100 mg/kg/d q12h | *Infants and children - [[Vancomycin]] 60 mg/kg/d q6h plus [[Ceftriaxone]] 100 mg/kg/d q12h | ||
Revision as of 18:42, 26 September 2014
Background
- Meningismus is difficult to discern if <6mo, (esp if <2mo)
- <3months old
- 1% incidence of bacterial meningitis
- E. coli, Group B strep, listeria
- >3months old
- S. pneumo, meningococcus, staph
Diagnosis
Bacterial Meningitis Score for >2mo and well-appearing
- Risk Factor
- Peripheral blood ANC >10K
- Seizure
- CSF
- CSF ANC >1000
- CSF protein >80
- CSF Gram stain (if + 61% Sn, 99% Sp)
- Any risk factor = high risk for bacterial meningitis
- Very low risk if infant lacks all risk factors
Work-Up
- CBC
- CSF
DDx
Treatment
- Neonates - IV ampicillin + gentamicin
- If suspecting S. pneumoniae, add vancomycin
- Empiric therapy for late-onset includes anti-staph agent plus ceftazidime, amikacin, or meropenem
- Ceftriaxone may cause bilirubin encephalopathy in neonates
- Infants and children - Vancomycin 60 mg/kg/d q6h plus Ceftriaxone 100 mg/kg/d q12h
- Length of Tx depends on organisms isolated
Disposition
- Admit despite negative meningitis score if:
- Age <2mo w/ any degree of pleocytosis
- Appear ill
- Infants w/ aseptic meningitis
- If likely viral meningitis still give ceftriaxone x 1, f/u in 24hr
See Also
Source
Tintinalli Lexicomp eMedicine - Pediatric Bacterial Meningitis