OUTLINE: *INITIAL STABILIZATION *ANTIBIOTICS THERAPY *STEROIDS *ICP MANAGEMENT *SYMPTOMATIC THERAPY *PROGNOSIS AND PREVENTION INITIAL STABILIZATION • Airway, breathing and circulation must be maintained • Correct shock, respiratory distress , multiple organ system failure • Paediatric intensive care unit (PICU) until the child is stable. • Monitoring of pulse rate, BP and respiratory rate • Frequent neurologic assessment

1. TREATMENT OF
ACUTE BACTERIAL MENINGITIS
RAMAGOPALAN S

2. OUTLINE:
INITIAL STABILIZATION
ANTIBIOTICS THERAPY
STEROIDS
ICP MANAGEMENT
SYMPTOMATIC THERAPY
PROGNOSIS AND PREVENTION

3. INITIAL STABILIZATION
• Airway, breathing and circulation must be
maintained
• Correct shock, respiratory distress , multiple
organ system failure
• Paediatric intensive care unit (PICU) until the
child is stable.
• Monitoring of pulse rate, BP and respiratory rate
• Frequent neurologic assessment

4. ANTIBIOTICS THERAPY
Appropriate antibiotics selection depends on:
• Causative pathogens
• Age of child
• Local incidence & resistance patterns
• Ability of drug to achieve bactericidal concentration
in CSF

5. ANTIBIOTICS THERAPY
Empirical therapy: (all antibiotics are administered intravenously)
A. Sensitive to beta lactam drungs:
• Penicillin – 1.5 to 4 lakhs unit/kg/24 hours every 4 to 6 hours or
• Cefotaxime- 300 mg/kg/24hrs every 6 hours or
• Ceftriaxone - 100 mg/kg/24hrs every 12 hours or
• Ampicillin – 200mg/kg and Chloramphenicol(100mg/kg/hr)
B. Resistance to beta lactam drungs:
• Vancomycin – 60 mg/kg/24hrs every 6 hours(30mg/kg for neonates)

6. ANTIBIOTICS THERAPY
Empirical therapy: (all antibiotics are administered intravenously)
D. Gram negative meningitis suspicion :
• For E.coli Ampicillin + gentamycin/ cefotaxime – Drug of choice
• If Pseudomonas is suspected - Ceftazidime
C. Allergic to beta lactam drungs:
• Chloramphenicol – 100 mg/kg/24hrs every 6 hours or
• Combination of vancomycin and Rifampin

7. ANTIBIOTICS THERAPY
Empirical therapy:
Source: IAP textbook of Paediatrics 6th edition

8. ANTIBIOTICS THERAPY
(Based on culture and sensitivity)

9. ANTIBIOTICS THERAPY
Duration of initial therapy:
• S.pneumoniae – 10 to 14 days
• H.influenzae type B – 7 to 10 days
• N.meningitidis – 5 to 7 days
• E.coli & P.aeruginosa and neonates – 3 weeks
Proper treatment:
• Gram stain –ve within 24 to 48 hours
• CSF glucose conc. Normalize over 72 hours

10. STEROIDS
Antibiotics
Bacterial
cell lysis
Cytokine
mediated
inflammation
Edema &
neutrophilic
infiltration
Neurological
injury
For this reason:
• IV dexamethasone
• 0.15 mg/kg every 6 hours for
2 days
• 1-2 hrs before antibiotics
• For HiB, Pneumococcus
• To Prevent deafness

11. ICP MANAGEMENT
• Endotracheal tube intubation and hyperventilation( to
maintain the Pco2 at 25mm Hg)
• IV furosemide – 1 mg/ kg and mannitol – 0.5 to 1g/kg
• Dopamine and norepinephrine to ↑ cerebral perfusion

12. SYMPTOMATIC THERAPY:
Seizures:
• Common during course of bacterial meningitis
• IV Diazepam 0.3 mg/kg(maximum 5mg)
• Followed by phenytoin 15-20 mg/kg loading dose and 5mg/kg day
maintenance dose
• Stopped after 3 months
Fluid and electrolyte homeostasis:

13. PROGNOSIS & SEQUELAE
Bad prognosis:
• Younger patient
• Late diagnosis
• Coma or focal neurological deficit
at presentation
• Pneumococcal meningitis
• CSF bacterial load
• Seizures occur more than 4 days
Neurological sequelae:
• Hearing impairment
• Visual impairment
• Cognitive impairment
• Recurrent seizures
• Hydrocephalous
• Developmental delay
• Permanent neurological deficit

14. PREVENTION AND FOLLOW UP
Chemoprophylaxis:
Organism Drug Dosage
H. Influenza Rifampicin 20mg/kg/days q12 for 4 days
Meningococcal Rifampicin
or
Ceftriaxone
20mg/kg/days q12 for 2 days
125 mg (<12 year)
250 mg (older) single IM
Vaccines:
• H.Influenzae B
• Meningococcal vaccine
• Pneumococcal vaccine