This guideline covers bacterial meningitis and meningococcal septicaemia, focusing on management of these conditions in children and young people aged younger than 16 years in primary and secondary care, and using evidence of direct relevance to these age groups where available.

Contents

• Guideline Development Group membership and acknowledgements
• 1. Summary of recommendations and care pathway
  • 1.1. Key priorities for implementation
  • 1.2. Recommendations
  • 1.3. Key priorities for research
  • 1.4. Research recommendations
  • 1.5. Care pathway
• 2. Development of the guideline
  • 2.1. Bacterial meningitis and meningococcal septicaemia in children and young people
  • 2.2. Aim and scope of the guideline
  • 2.3. For whom is the guideline intended?
  • 2.4. Other relevant documents
  • 2.5. Who has developed the guideline?
  • 2.6. Guideline development methodology
  • 2.7. Specific considerations for this guideline
  • 2.8. Schedule for updating the guideline
• 3. Bacterial meningitis and meningococcal septicaemia in children and young people — symptoms, signs and initial assessment
  • 3.1. Symptoms and signs of bacterial meningitis
  • 3.2. Symptoms and signs of meningococcal septicaemia
• 4. Pre-hospital management of suspected bacterial meningitis and meningococcal septicaemia
  • 4.1. Pre-hospital antibiotics for suspected bacterial meningitis and meningococcal disease
• 5. Diagnosis in secondary care
  • 5.1. Non-specific tests for meningococcal disease
  • 5.2. Non-specific tests for bacterial meningitis
  • 5.3. Polymerase chain reaction tests for bacterial meningitis and meningococcal disease
  • 5.4. Skin samples and throat swabs for meningococcal disease
  • 5.5. Performing lumbar puncture and interpreting cerebrospinal fluid parameters for suspected bacterial meningitis
  • 5.6. Contraindications to lumbar puncture
  • 5.7. Repeat lumbar puncture in neonates
  • 5.8. Cranial computed tomography for suspected bacterial meningitis
• 6. Management in secondary care
  • 6.1. Antibiotics for suspected bacterial meningitis or meningococcal disease
  • 6.2. Treatment for specific infections in confirmed bacterial meningitis
  • 6.3. Fluid management in suspected or confirmed bacterial meningitis
  • 6.4. Intravenous fluid resuscitation in meningococcal septicaemia
  • 6.5. Type and volume of intravenous fluids for meningococcal septicaemia
  • 6.6. Respiratory support in children and young people with suspected or confirmed bacterial meningitis or meningococcal septicaemia
  • 6.7. Corticosteroids for bacterial meningitis
  • 6.8. Corticosteroids for meningococcal septicaemia
  • 6.9. Adjunctive therapies
  • 6.10. Monitoring for deterioration for meningococcal disease Introduction
  • 6.11. Retrieval and transfer to tertiary care
• 7. Long-term management
  • Introduction
  • 7.1. Long-term effects of bacterial meningitis
  • 7.2. Long-term effects of meningococcal disease
  • 7.3. Immune testing
• 8. References, glossary and abbreviations
  • References
  • Abbreviations
  • Glossary of terms
  • Health economics terms
• Appendix A. Scope
• Appendix B. Declarations of interest
• Appendix C. Registered stakeholder organisations
• Appendix D. Clinical questions
• Appendix E. Search strategies
• Appendix F. Excluded studies
• Appendix G. Included studies evidence tables
• Appendix H. Meta-analyses (Forest plots) conducted as part of guideline development
• Appendix I. Cost effectiveness of polymerase chain reaction for diagnosis in suspected meningococcal disease
• Appendix J. Cost effectiveness of antibiotics for treatment of bacterial meningitis and meningococcal disease
• Appendix K. Cost effectiveness of crystalloid versus colloid intravenous fluid for resuscitation in suspected meningococcal septicaemia
• Appendix L. Cost effectiveness of complement deficiency screening in survivors of meningococcal disease

First published June 2010, revised reprint September 2010

While every effort has been made to ensure the accuracy of the information contained within this publication, the publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check current indications and accuracy by consulting other pharmaceutical literature and following the guidelines laid down by the manufacturers of specific products and the relevant authorities in the country in which they are practising.

This guideline has been fully funded by NICE. Healthcare professionals are expected to take it fully into account when exercising their clinical judgement. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient.

Implementation of this guidance is the responsibility of local commissioners and/or providers.