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Bacterial meningitis in children older than one month: Treatment and prognosis

Sheldon L Kaplan, MD
Section Editors
Morven S Edwards, MD
Douglas R Nordli, Jr, MD
Deputy Editor
Carrie Armsby, MD, MPH


Suspected bacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause so that appropriate antimicrobial therapy can be initiated. The mortality rate of untreated bacterial meningitis approaches 100 percent and, even with optimal therapy, morbidity and mortality may occur. Neurologic sequelae are common among survivors.

The treatment and prognosis of bacterial meningitis in infants and children older than one month will be reviewed here. The pathogenesis, epidemiology, clinical features and diagnosis of acute bacterial meningitis and the treatment and prognosis of bacterial meningitis in neonates (<1 month of age) and adults are discussed separately. (See "Pathogenesis and pathophysiology of bacterial meningitis" and "Bacterial meningitis in children older than one month: Clinical features and diagnosis" and "Bacterial meningitis in the neonate: Treatment and outcome" and "Initial therapy and prognosis of bacterial meningitis in adults" and "Treatment of bacterial meningitis caused by specific pathogens in adults".)


There are a number of general principles of antibiotic therapy in patients with bacterial meningitis. The most important initial issues are avoidance of delay in administering therapy and the choice of drug regimen.

Avoidance of delay — Antibiotic therapy should be initiated immediately after lumbar puncture (LP) is performed if the clinical suspicion for meningitis is high (algorithm 1). Delay in the administration of appropriate antibiotics can have a deleterious effect on outcome for patients who are deteriorating rapidly.

If computed tomography (CT) scan is to be performed before LP, antibiotic therapy should be initiated immediately after blood cultures are obtained, before the CT is performed. Although the administration of antimicrobial therapy before LP may affect the yield of cerebrospinal fluid (CSF) Gram stain and culture, pathogens other than meningococcus usually can be identified in the CSF up to several hours after the administration of antibiotics [1-3]. (See "Bacterial meningitis in children older than one month: Clinical features and diagnosis", section on 'Interpretation of CSF in pretreated patients'.)


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Literature review current through: Sep 2016. | This topic last updated: Jun 8, 2015.
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