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Pediatric Bacterial Meningitis Treatment & Management

Pediatric Bacterial Meningitis Treatment & Management

by: Dr. Sorabh Goel
Consultant - Neonatology-Paras Bliss, Panchkula

Meningitis is a life threatening infection of brain caused by various infective organisms like viruses and bacteria. Bacterial meningitis is more severe and can cause even death if not diagnosed and treated early.

Symptoms associated with Meningitis:

  • The affected child can present with nonspecific complaints like fever, loss of apetite, body pains, and joint pains, symptoms of diarrhoea or upper respiratory infections.
  • Suspicion of meningitis is high if child has associated headache, vomiting and skin rash. Child may also complain of photophobia (sensitivity to light).
  • Do consult a paediatrician if the child has even mild symptoms, has irritable behaviour and excessive lethargy or sleep. The affected child at times may have abnormal body movements or seizures and even unconsciousness/coma.

Diagnosis of Meningitis:

Lumbar puncture and CSF examination is the only gold standard for diagnosis of meningitis.

Treatment of Meningitis:

The affected child may need treatment under close supervision of trained hands. It needs a triad approach, where all steps are to be taken simultaneously.

  • Antibiotics: Definitive treatment for meningitis is antibiotics. It should be started once we suspect meningitis after lumbar puncture.  The choice of antibiotic depends on the age of the child and the immune status. Duration of antibiotic therapy is equally important as is the choice of antibiotic. Duration varies from 7-14 days depending on the causative agent. Younger children may need longer duration of treatment for complete cure. If not treated with appropriate antibiotics for adequate duration, it can lead to chronic meningitis and ventriculitis, which are even more difficult to treat.
  • Corticosteroids: Rapid bacterial killing with antibiotics may precipitate inflammatory reactions in brain, which may result in more brain injury and complications. So administrating corticosteroid along with antibiotics have improved outcome in meningitis cases caused by hemophillus influenza.
  • Supportive care: Repeated medical and neurological assessment of child with bacterial meningitis is very important to detect involvement of other systems at an early stage and any neurological complications if child develops. Child needs IV Fluids and other medicine especially to control seizure and to decrease brain pressure.

Complications associated with Meningitis :  

Child can develop complications like seizures, paralysis, subdural effusion, shock, multiple organ involvement and bleeding tendencies. These complications also need to be managed aggressively for better outcome. Major long term complications if the child is not treated adequately are physical disability, seizures, poor school performance and low IQ. The affected child can also have hearing loss of varying severity. So early treatment prevents complications and improves the outcome.

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