Bacterial meningitis in children

Bacterial meningitis is a life-threatening inflammation of the meninges, which most commonly affects young children (<2 years of age) because of impaired immunity. It is a notifiable disease in the UK.

You should strongly suspect bacterial meningitis when assessing any child or young person that has red flag symptoms; fever, headache, neck stiffness, or altered level of consciousness or cognition (including confusion or delirium). Symptoms and signs may be more difficult to identify in young people and young adults, who may appear well at presentation.

If you suspect bacterial meningitis, obtain cerebrospinal fluid by performing a lumbar puncture (unless contraindicated); this is the most important investigation. Blood tests and lumbar puncture are performed before starting antibiotics (if it is safe to do so and will not cause a clinically significant delay to starting antibiotics).

Start empirical antimicrobial therapy promptly and within 1 hour of the child arriving at hospital. When the specific organism is identified, target treatment accordingly.

Streptococcus pneumoniae (pneumococcus) and Neisseria meningitidis (meningococcus) are the predominant causative pathogens in children ≥3 months, while Streptococcus agalactiae (group B streptococcus) and Escherichia coli are the most common causative pathogens in neonates.[1]Okike IO, Johnson AP, Henderson KL, et al. Incidence, etiology, and outcome of bacterial meningitis in infants aged <90 days in the United kingdom and Republic of Ireland: prospective, enhanced, national population-based surveillance. Clin Infect Dis. 2014 Nov 15;59(10):e150-7. https://academic.oup.com/cid/article/59/10/e150/2895279 http://www.ncbi.nlm.nih.gov/pubmed/24997051?tool=bestpractice.com [2]National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. Mar 2024 [internet publication]. https://www.nice.org.uk/guidance/ng240/chapter/Recommendations ​​[3]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://linkinghub.elsevier.com/retrieve/pii/S1198-743X(16)00020-3 http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com

This topic covers bacterial meningitis acquired by children in the community; meningitis may also be associated with invasive procedures or head trauma, but healthcare-associated meningitis and infants with meningitis in neonatal units are beyond the scope of this topic. Features of meningococcal disease other than meningococcal meningitis are not covered in this topic - see Meningococcal disease.