Overview

Investigations

Contraindication to lumbar puncture (any signs of raised ICP)

• focal neurological signs
• papilloedema
• significant bulging of the fontanelle
• disseminated intravascular coagulation
• signs of cerebral herniation

For patients with meningococcal septicaemia a lumbar puncture is contraindicated - blood cultures and PCR for meningococcus should be obtained.

Management

1. Antibiotics

• < 3 months: IV amoxicillin (or ampicillin) + IV cefotaxime

• 3 months: IV cefotaxime (or ceftriaxone)

2. Steroids

• NICE advise against giving corticosteroids in children younger than 3 months, dexamethasone should be considered if the lumbar puncture reveals any of the following:
• frankly purulent CSF
• CSF white blood cell count greater than 1000/microlitre
• raised CSF white blood cell count with protein concentration greater than 1 g/litre
• bacteria on Gram stain