PE27.1 | Acute Bacterial Meningitis — Summary & Reflection

KEY TAKEAWAYS

Acute Bacterial Meningitis — Key Points

• Organism by age: Neonates (0–28 days) → GBS, E. coli, Listeria; Children >3 months → S. pneumoniae (commonest), N. meningitidis, Hib
• Clinical features: Non-specific in neonates (bulging fontanelle, hypothermia, poor feeding); classic triad (fever, neck stiffness, altered consciousness) + Kernig's/Brudzinski's in older children; non-blanching rash = meningococcaemia until proven otherwise
• CSF in bacterial meningitis: Turbid, ↑opening pressure, ↑WBC (neutrophil-predominant >80%), ↑protein, ↓glucose (CSF:serum ratio <0.40)
• Empirical treatment: Neonates — ampicillin + cefotaxime (NOT ceftriaxone); >3 months — ceftriaxone + vancomycin
• Dexamethasone: 0.15 mg/kg IV q6h × 4 days — given BEFORE or WITH the first antibiotic dose; best evidence for Hib-associated hearing loss reduction
• Complications: Raised ICP, SIADH, subdural empyema, sensorineural hearing loss (audiological assessment mandatory in all survivors), cerebral palsy, hydrocephalus
• Prevention: Pentavalent vaccine (Hib), PCV13/PCV10 (pneumococcal), meningococcal vaccine for high-risk; rifampicin prophylaxis for close contacts of meningococcal/Hib cases; GBS screening + intrapartum prophylaxis for neonatal GBS

REFLECT

Reflect on the following: A family brings their 8-month-old child to your PHC with fever and irritability. The child is not vaccinated — the parents moved recently and records were lost. You suspect meningitis. The nearest hospital with CSF analysis capability is 45 minutes away. What would you do in the next 10 minutes, and why? Consider the trade-offs between initiating treatment before diagnosis is confirmed and the real-world barriers to doing so. How does this scenario change if the child is a neonate versus an 8-month-old?