Pediatric Meningitis and Encephalitis Treatment & Management

  • Author: Jeffrey Hom, MD, MPH, FACEP, FAAP; Chief Editor: Richard G Bachur, MD   more...
 
Updated: Apr 19, 2011
 

Prehospital Care

  • Prehospital care usually is confined to transporting children who are critically ill or have experienced a seizure from the meningitis or encephalitis.
  • General supportive care is required depending on the child's condition.
  • Subsequent diagnosis of a potentially transmissible disease must be communicated to prehospital care providers, especially with N meningitidis infections.
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Emergency Department Care

  • Immediate stabilization and support of the critically ill or seizing child is necessary.
  • When meningitis or encephalitis is suspected, a lumbar puncture (LP) is indicated. Adequate analgesia is essential, with recent studies indicating only 1 in 7 infants receive any pain management during LP.[18]
    • If the child's condition is unstable or there is suspicion of increased intracranial pressure, the LP should be delayed.
    • It is very important that antibiotic therapy is immediately commenced in the ill child and not delayed until after the LP.
    • If prompt LP cannot be performed, administration of antibiotics should be initiated. However, sterilization of CSF will occur. It was previously thought that sterilization occurs within 2-3 hours. However, in a retrospective study, complete sterilization was found to occur within 2 hours for meningococcal meningitis. With pneumonococcal infections, sterilization occurred within 4 hours.
  • If the child is hemodynamically stable, intravenous fluids should be administered at maintenance. Careful record of the patient's weight, urine specific gravity, and serum osmolarity will help guide further fluid therapy. Patients who present with dehydration need rehydration and should not have fluid restriction. Seizures should be treated promptly and should be expected at any time during the initial management.
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Consultations

  • Children with bacterial meningitis require hospitalization for intravenous antibiotics and appropriate support.
    • Depending on the child's condition, admission to a pediatric intensive care unit may be warranted.
    • Regardless, consultation with a pediatrician, infectious disease specialist, and/or a critical care specialist may be needed.
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Contributor Information and Disclosures
Author

Jeffrey Hom, MD, MPH, FACEP, FAAP  Assistant Professor, Department of Pediatrics/Emergency Services and Department of Emergency Medicine, New York University School of Medicine

Jeffrey Hom, MD, MPH, FACEP, FAAP is a member of the following medical societies: American Academy of Pediatrics, American College of Emergency Physicians, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Robert Allan Felter, MD, FAAP, CPE, FACPE  Professor of Clinical Pediatrics, Department of Pediatrics, Georgetown University School of Medicine; Medical Director, Pediatric Emergency Medicine and Inpatient Services, Inova Loudoun Hospital

Robert Allan Felter, MD, FAAP, CPE, FACPE is a member of the following medical societies: American Academy of Pediatrics and American College of Physician Executives

Disclosure: Nothing to disclose.

Specialty Editor Board

Garry Wilkes, MBBS, FACEM  Director of Emergency Medicine, Bunbury Hospital; Medical Consultant, St John Ambulance, WA Ambulance Service; Adjunct Associate Professor, Edith Cowan University; Clinical Associate Professor, Rural Clinical School, University of Western Australia

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Grace M Young, MD  Associate Professor, Department of Pediatrics, University of Maryland Medical Center

Grace M Young, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Emergency Physicians

Disclosure: Nothing to disclose.

John D Halamka, MD, MS  Associate Professor of Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center; Chief Information Officer, CareGroup Healthcare System and Harvard Medical School; Attending Physician, Division of Emergency Medicine, Beth Israel Deaconess Medical Center

John D Halamka, MD, MS is a member of the following medical societies: American College of Emergency Physicians, American Medical Informatics Association, Phi Beta Kappa, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Chief Editor

Richard G Bachur, MD  Associate Professor of Pediatrics, Harvard Medical School; Associate Chief and Fellowship Director, Attending Physician, Division of Emergency Medicine, Children's Hospital of Boston

Richard G Bachur, MD is a member of the following medical societies: American Academy of Pediatrics, Society for Academic Emergency Medicine, and Society for Pediatric Research

Disclosure: Nothing to disclose.

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