Treatment of Meningitis in Children - An Overview

Introduction
Suspected bacterial meningitis is a medical emergency, and immediate diagnostic steps must be taken to establish the specific cause so that appropriate antimicrobial therapy can be initiated. The mortality rate of untreated bacterial meningitis approaches 100 percent and, even with optimal therapy, morbidity and mortality may occur. Neurologic sequelae are common among survivors.

Self-Care at Home
Meningitis can be a rapidly progressing, life-threatening disease, so immediate medical care is important if meningitis is suspected in a child.
While transporting a child to a hospital’s emergency department, supportive care may include the following:

• Give the correct amount of acetaminophen for fever.
• Attempt to keep the child comfortable and prevent the child from choking or inhaling any material vomited.
• Directly observe the child to notice any deterioration in condition.
• Sometimes, children are sent home from the emergency room if the doctor is confident that the child has viral meningitis. Frequently, a child with viral meningitis can be treated successfully at home by taking acetaminophen or other pain medications and by drinking plenty of fluids. If a child has viral meningitis, follow-up care is still important.
• Have the child reevaluated within 1-2 days to be sure that he or she is improving.
• Watch for any worsening signs or symptoms and if necessary, return immediately to a medical facility.

Avoidance of delay — Antibiotic therapy should be initiated immediately after lumbar puncture (LP) is performed if the clinical suspicion for meningitis is high .Delay in the administration of appropriate antibiotics can have a deleterious effect on outcome for patients who are deteriorating rapidly.

• If any indication of respiratory distressis present, a breathing tube (intubation) may be needed to provide oxygen to helpthe child breathe.
• A heart monitor is connected to accurately measurethe child’s heart rate and rhythm.
• An IV is started to give fluids and to correct any dehydration. An IV also helps tomaintain blood pressure and good circulation.
• A tube (catheter) may be placed in thebladder to obtain urine and tohelp accurately measure the child’s hydration.

Need For Intensive Care Unit: A child who has meningitis or is suspected to have meningitis is admitted to the hospital. The type of monitoring, such as in a pediatric intensive care unit, is determined by the doctor in the emergency department and the doctors who care for the child in the hospital.

Steroids may be given to help minimize inflammation depending on which organism is suspected to be causing the infection.
More aggressive medications may be necessary depending on the severity of the child’s illness.

If computed tomography (CT) scan is to be performed before LP, antibiotic therapy should be initiated immediately after blood cultures are obtained. Although the administration of antimicrobial therapy before LP may affect the yield of cerebrospinal fluid (CSF) Gram stain and culture, pathogens other than meningococcus usually can be identified in the CSF up to several hours after the administration of antibiotics
Medical Treatment

Because meningitis is a potentially life-threatening infection, therapy often begins before the test resultsare back.

Medications
Antibiotics may be given early in treatment of meningitis to help fight the infection as quickly as possible. The type of antibiotic depends on the child’s age and any known allergies. Antibiotics are not helpful for viral meningitis.