Nigrovic LE, Malley R, Kuppermann N. Meta-analysis of bacterial meningitis score validation studies. Arch Dis Child. 2012 Jul 4. [QxMD MEDLINE Link].
[Guideline] Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004 Nov 1. 39(9):1267-84. [QxMD MEDLINE Link].
AAP. Pickering LK, Baker CJ, Kimberlin DW, et al eds. 2009 Red Book. 28th ed. American Academy of Pediatrics; 2009.
Ouchenir L, Renaud C, Khan S, Bitnun A, Boisvert AA, McDonald J, et al. The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants. Pediatrics. 2017 Jul. 140 (1):[QxMD MEDLINE Link].
Sridhar S, Greenwood B, Head C, et al. Global incidence of serogroup B invasive meningococcal disease: a systematic review. Lancet Infect Dis. 2015 Nov. 15 (11):1334-46. [QxMD MEDLINE Link].
Haddy RI, Perry K, Chacko CE, Helton WB, Bowling MG, Looney SW, et al. Comparison of incidence of invasive Streptococcus pneumoniae disease among children before and after introduction of conjugated pneumococcal vaccine. Pediatr Infect Dis J. 2005 Apr. 24(4):320-3. [QxMD MEDLINE Link].
Nigrovic LE, Kuppermann N, Malley R. Children with bacterial meningitis presenting to the emergency department during the pneumococcal conjugate vaccine era. Acad Emerg Med. 2008 Jun. 15(6):522-8. [QxMD MEDLINE Link].
Nigrovic LE, Malley R, Kuppermann N. Cerebrospinal fluid pleocytosis in children in the era of bacterial conjugate vaccines: distinguishing the child with bacterial and aseptic meningitis. Pediatr Emerg Care. 2009 Feb. 25(2):112-7; quiz 118-20. [QxMD MEDLINE Link].
Thigpen MC, Whitney CG, Messonnier NE, et al. Bacterial meningitis in the United States, 1998-2007. N Engl J Med. 2011 May 26. 364(21):2016-25. [QxMD MEDLINE Link].
MacNeil JR, Bennett N, Farley MM, Harrison LH, Lynfield R, Nichols M, et al. Epidemiology of infant meningococcal disease in the United States, 2006-2012. Pediatrics. 2015 Feb. 135 (2):e305-11. [QxMD MEDLINE Link].
Levine OS, Knoll MD, Jones A, Walker DG, Risko N, Gilani Z. Global status of Haemophilus influenzae type b and pneumococcal conjugate vaccines: evidence, policies, and introductions. Curr Opin Infect Dis. 2010 Jun. 23(3):236-41. [QxMD MEDLINE Link].
O'Brien KL, Wolfson LJ, Watt JP, Henkle E, Deloria-Knoll M, McCall N, et al. Burden of disease caused by Streptococcus pneumoniae in children younger than 5 years: global estimates. Lancet. 2009 Sep 12. 374(9693):893-902. [QxMD MEDLINE Link].
Watt JP, Wolfson LJ, O'Brien KL, Henkle E, Deloria-Knoll M, McCall N, et al. Burden of disease caused by Haemophilus influenzae type b in children younger than 5 years: global estimates. Lancet. 2009 Sep 12. 374(9693):903-11. [QxMD MEDLINE Link].
McIntyre PB, Macintyre CR, Gilmour R, Wang H. A population based study of the impact of corticosteroid therapy and delayed diagnosis on the outcome of childhood pneumococcal meningitis. Arch Dis Child. 2005 Apr. 90(4):391-6. [QxMD MEDLINE Link]. [Full Text].
Kutz JW, Simon LM, Chennupati SK, Giannoni CM, Manolidis S. Clinical predictors for hearing loss in children with bacterial meningitis. Arch Otolaryngol Head Neck Surg. 2006 Sep. 132(9):941-5. [QxMD MEDLINE Link].
Molyneux E, Nizami SQ, Saha S, et al. 5 versus 10 days of treatment with ceftriaxone for bacterial meningitis in children: a double-blind randomised equivalence study. Lancet. 2011 May 28. 377(9780):1837-45. [QxMD MEDLINE Link].
Ku LC, Boggess KA, Cohen-Wolkowiez M. Bacterial meningitis in infants. Clin Perinatol. 2015 Mar. 42 (1):29-45, vii-viii. [QxMD MEDLINE Link].
Nigrovic LE, Kuppermann N, Macias CG, Cannavino CR, Moro-Sutherland DM, Schremmer RD, et al. Clinical prediction rule for identifying children with cerebrospinal fluid pleocytosis at very low risk of bacterial meningitis. JAMA. 2007 Jan 3. 297(1):52-60. [QxMD MEDLINE Link].
Dubos F, Korczowski B, Aygun DA, Martinot A, Prat C, Galetto-Lacour A, et al. Serum procalcitonin level and other biological markers to distinguish between bacterial and aseptic meningitis in children: a European multicenter case cohort study. Arch Pediatr Adolesc Med. 2008 Dec. 162(12):1157-63. [QxMD MEDLINE Link].
Dubos F, Martinot A, Gendrel D, Bréart G, Chalumeau M. Clinical decision rules for evaluating meningitis in children. Curr Opin Neurol. 2009 Jun. 22(3):288-93. [QxMD MEDLINE Link].
Kanegaye JT, Nigrovic LE, Malley R, Cannavino CR, Schwab SH, Bennett JE, et al. Diagnostic value of immature neutrophils (bands) in the cerebrospinal fluid of children with cerebrospinal fluid pleocytosis. Pediatrics. 2009 Jun. 123(6):e967-71. [QxMD MEDLINE Link].
Greenberg RG, Smith PB, Cotten CM, Moody MA, Clark RH, Benjamin DK Jr. Traumatic lumbar punctures in neonates: test performance of the cerebrospinal fluid white blood cell count. Pediatr Infect Dis J. 2008 Dec. 27(12):1047-51. [QxMD MEDLINE Link]. [Full Text].
Neuman MI, Tolford S, Harper MB. Test characteristics and interpretation of cerebrospinal fluid gram stain in children. Pediatr Infect Dis J. 2008 Apr. 27(4):309-13. [QxMD MEDLINE Link].
Byington CL, Kendrick J, Sheng X. Normative cerebrospinal fluid profiles in febrile infants. J Pediatr. 2011 Jan. 158(1):130-4. [QxMD MEDLINE Link]. [Full Text].
Ray B, Rylance G. QUESTION 1. Normal CSF: does it exclude meningitis?. Arch Dis Child. 2009 Dec. 94(12):988-91. [QxMD MEDLINE Link].
Ye Q, Shao WX, Shang SQ, et al. Clinical Value of Assessing Cytokine Levels for the Differential Diagnosis of Bacterial Meningitis in a Pediatric Population. Medicine (Baltimore). 2016 Mar. 95 (13):e3222. [QxMD MEDLINE Link]. [Full Text].
Nigrovic LE, Malley R, Macias CG, Kanegaye JT, Moro-Sutherland DM, Schremmer RD, et al. Effect of antibiotic pretreatment on cerebrospinal fluid profiles of children with bacterial meningitis. Pediatrics. 2008 Oct. 122(4):726-30. [QxMD MEDLINE Link].
Fein D, Avner JR, Khine H. Pattern of pain management during lumbar puncture in children. Pediatr Emerg Care. 2010 May. 26(5):357-60. [QxMD MEDLINE Link].
Boelman C, Shroff M, Yau I, et al. Antithrombotic therapy for secondary stroke prevention in bacterial meningitis in children. J Pediatr. 2014 Oct. 165(4):799-806. [QxMD MEDLINE Link]. [Full Text].
Karageorgopoulos DE, Valkimadi PE, Kapaskelis A, Rafailidis PI, Falagas ME. Short versus long duration of antibiotic therapy for bacterial meningitis: a meta-analysis of randomised controlled trials in children. Arch Dis Child. 2009 Aug. 94(8):607-14. [QxMD MEDLINE Link].
van de Beek D, Brouwer MC. No difference between short-course and long-course antibiotics for bacterial meningitis in children, but available evidence limited. Evid Based Med. 2010 Feb. 15(1):6-7. [QxMD MEDLINE Link].
van de Beek D, de Gans J, McIntyre P, Prasad K. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2007. (1):CD004405. [QxMD MEDLINE Link].
Mongelluzzo J, Mohamad Z, Ten Have TR, Shah SS. Corticosteroids and mortality in children with bacterial meningitis. JAMA. 2008 May 7. 299(17):2048-55. [QxMD MEDLINE Link].
[Guideline] Saari TN. Immunization of preterm and low birth weight infants. American Academy of Pediatrics Committee on Infectious Diseases. Pediatrics. 2003 Jul. 112(1 Pt 1):193-8. [QxMD MEDLINE Link].
Centers for Disease Control and Prevention (CDC). Ten great public health achievements--worldwide, 2001-2010. MMWR Morb Mortal Wkly Rep. 2011 Jun 24. 60(24):814-8. [QxMD MEDLINE Link].
Mahoney D. ACIP gives nod to meningitis vaccine for high-risk infants. Medscape Medical News. October 26, 2012. Accessed Nov 13, 2012.:
Centers For Disease Control and Prevention. CDC Advisory Committee on Immunization Practices Recommends HibMenCY for Infants at Increased Risk for Meningococcal Disease. Oct 24, 2012. Available at: Accessed Nov 13, 2012. [Full Text].
Cohn AC, MacNeil JR, Clark TA, Ortega-Sanchez IR, Briere EZ, Meissner HC, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2013 Mar 22. 62:1-28. [QxMD MEDLINE Link].
Novartis Vaccines. FDA expands age indication for Menveo®, first and only quadrivalent meningococcal vaccine for infants as young as 2 months of age. Available at http://www.novartisvaccines.com/newsroom/media-releases/2013/US_Menveo_Infant_FDA_Approval_Press_Release_US.pdf. Accessed: August 7, 2013.
Thomson J, Sucharew H, Cruz AT, Nigrovic LE, Freedman SB, Garro AC, et al. Cerebrospinal Fluid Reference Values for Young Infants Undergoing Lumbar Puncture. Pediatrics. 2018 Mar. 141 (3):672-81. [QxMD MEDLINE Link].

Media Gallery

Acute bacterial meningitis. This axial nonenhanced CT scan shows mild ventriculomegaly and sulcal effacement.
Acute bacterial meningitis. This axial T2-weighted MRI shows only mild ventriculomegaly.
Acute bacterial meningitis. This contrast-enhanced, axial T1-weighted MRI shows leptomeningeal enhancement (arrows).

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Table 1. Antibiotic Dosages for Neonatal Bacterial Meningitis, Adjusted by Weight and Age

Antibiotic	Route	Dosage
Antibiotic	Route	Birth Weight < 2000 g, Age 0-7 Days	Birth Weight >2000 g, Age 0-7 Days	Birth Weight < 2000 g, Age >7 Days	Birth Weight >2000 g, Age >7 Days
Penicillins
Ampicillin	IV, IM	50 mg/kg q12h	50 mg/kg q8h	50 mg/kg q8h	50 mg/kg q6h
Penicillin G	IV	50,000 U/kg q12h	50,000 U/kg q8h	50,000 U/kg q8h	50,000 U/kg q6h
Oxacillin	IV, IM	50 mg/kg q12h	50 mg/kg q8h	50 mg/kg q8h	50 mg/kg q6h
Ticarcillin	IV, IM	75 mg/kg q12h	75 mg/kg q8h	75 mg/kg q8h	75 mg/kg q6h
Cephalosporins
Cefotaxime	IV, IM	50 m mg/kg g q12h	50 mg/kg q8h	50 mg/kg q8h	50 mg/kg q6h
Ceftriaxone	IV, IM	50 mg/kg qd	50 mg/kg qd	50 mg/kg qd	75 mg/kg qd
Ceftazidime	IV, IM	50 mg/kg q12h	50 mg/kg q8h	50 mg/kg q8h	50 mg/kg q8h

Table 2. Antibiotics for Neonatal Bacterial Meningitis That Must Be Dosed According to Serum levels

Antibiotic	Route	Desired Serum level, µg/mL	Dosage
Antibiotic	Route	Desired Serum level, µg/mL	Birth Weight < 2000 g, Age 0-7 Days*	Birth Weight >2000 g, Age 0-7 Days*	Birth Weight < 2000 g, Age >7 Days*	Birth Weight >2000 g, Age >7 Days*
Aminoglycosides
Amikacin†	IV, IM	20-30 (peak), < 10 (trough)	7.5 mg/kg q12h	10 mg/kg q12h	10 mg/kg q8h	10 mg/kg q8h
Gentamicin†	IV, IM	5-10 (peak), < 2.5 (trough)	2.5 mg/kg q12h	2.5 mg/kg q12h	2.5 mg/kg q8h	2.5 mg/kg q8h
Tobramycin†	IV, IM	5-10 (peak), < 2.5 (trough)	2.5 mg/kg q12h	2.5 mg/kg q12h	2.5 mg/kg q8h	2.5 mg/kg q8h
Glycopeptide
Vancomycin*†	IV, IM	20-40 (peak), < 10 (trough)	15 mg/kg q12h	15 mg/kg q8h	15 mg/kg q8h	15 mg/kg q6h
*The dosage stated is the highest within the dosage range. † Serum levels must be monitored when patient has kidney disease or is receiving other nephrotoxic drugs; adjust doses accordingly.

Table 3. Dosages and Dosing Intervals for Intravenous Antimicrobials in Infants and Children With Bacterial Meningitis

Antibiotic	IV Dosage	Maximum Daily Dose	Dosing Interval
Ampicillin	400 mg/kg/day	6-12 g	q6h
Vancomycin	60 mg/kg/day	2-4 g	q6h
Penicillin G	400,000 U/kg/day	24 million U	q6h
Cefotaxime	200-300 mg/kg/day	8-10 g	q6h
Ceftriaxone	100 mg/kg/day	4 g	q12h
Ceftazidime	150 mg/kg/day	6 g	q8h
Cefepime*	150 mg/kg/day	2-4 g	q8h
Imipenem†	60 mg/kg/day	2-4 g	q6h
Meropenem	120 mg/kg/day	4-6 g	q8h
Rifampin	20 mg/kg/day	600 mg	q12h
*Experience with this agent in pediatric patients is minimal; it is not licensed for treatment of meningitis. † Because of possible seizures, this agent must be used with caution in treating meningitis.

Table 4. Chemoprophylaxis for Bacterial Meningitis Caused by Haemophilus influenzae or Neisseria meningitidis

Causative Organism	Drug Name	Age of Contact	Dosage
Haemophilus influenzae	Rifampin	Adults	>600 mg PO qd for 4 days
		=1 month	20 mg/kg PO qd for 4 days; not to exceed 600 mg/dose
		< 1 month	>10 mg/kg PO qd for 4 days
Neisseria meningitidis	Rifampin	Adults	600 mg PO q12h for 2 days
		>1 month	10 mg/kg PO q12h for 2 days; not to exceed 600 mg/dose
		=1 month	>5 mg/kg PO q12h for 2 days
	Ceftriaxone	>15 years	250 mg IM once
		=15 years	>125 mg IM once
	Ciprofloxacin	=18 years	>500 mg PO once

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Author

Martha L Muller, MD, MPH Professor of Pediatrics, Division of Infectious Diseases, University of New Mexico School of Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

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.

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa

Disclosure: Received research grant from: Pfizer;GlaxoSmithKline;AstraZeneca;Merck;American Academy of Pediatrics, Novavax, Regeneron, Diassess, Actelion<br/>Received income in an amount equal to or greater than $250 from: Sanofi Pasteur.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Joseph Domachowske, MD Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa