Skip to textbook content
Doctor’s PassportTextbook
TopicsAll topics

Loading topic navigation…

Textbook navigation
TopicsAll topics

Loading topic navigation…
Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.

Meningitis and encephalitis

Paediatrics and child health · UK scope · Sources checked 27 Aug 2026 · Clinical review pending

RapidFull
!
Suspected central nervous system infection

Fever with meningism, non-blanching rash, encephalopathy, focal neurology, seizure, bulging fontanelle, shock or rapidly progressive illness requires emergency hospital treatment.

Action: Use ABCDE, obtain blood cultures and essential samples if this does not delay therapy, give empirical intravenous antibiotics within one hour of hospital arrival and add intravenous aciclovir when encephalitis is suspected.

Synopsis

Recognise age-specific central nervous system infection, stabilise sepsis and seizures, start empirical antibiotics and aciclovir without delay and use lumbar puncture and imaging only when safe and informative.

  • Do not wait for the full fever, neck stiffness, rash and altered-consciousness triad; presentation varies by age and disease stage.
  • In infants, poor feeding, irritability, abnormal cry, apnoea, temperature instability, bulging fontanelle or reduced interaction may be the only early clues.
  • Start empirical intravenous antibiotics within one hour of hospital arrival when bacterial meningitis is suspected; blood sampling or imaging must not create avoidable delay.
  • Perform lumbar puncture promptly after stabilisation when it is safe, ideally before antibiotics, but never delay antibiotics for an unsafe or logistically delayed puncture.
  • Do not routinely image before lumbar puncture; image first when focal signs, abnormal pupils, papilloedema, severe impaired consciousness or another raised-pressure feature is present.
  • Suspected encephalitis means altered mental state with seizure, focal deficit, behaviour or language change; add intravenous aciclovir while urgent diagnostic testing proceeds.
  • For babies over three months and children with strongly suspected or confirmed bacterial meningitis, give dexamethasone with or before the first antibiotic when possible, without delaying antibiotics.
  • Notify suspected meningococcal disease urgently and involve the UKHSA health protection team for contact risk assessment and chemoprophylaxis.
  • Arrange formal audiological assessment after bacterial meningitis and developmental, neurological and educational follow-up according to complications.
  • A negative early culture after antibiotics does not exclude infection; integrate cerebrospinal fluid cells, protein, paired glucose and PCR with the clinical course.

Key red flags

A non-blanching petechial or purpuric rash with fever or systemic illness suggests meningococcal disease, but absence of rash does not exclude bacterial meningitis.

Infants may show poor feeding, temperature instability, irritability, apnoea, bulging fontanelle or abnormal cry rather than neck stiffness.

Altered behaviour, reduced consciousness, focal seizure, language change or new focal deficit suggests encephalitis or intracranial complication.

Shock, prolonged capillary refill, respiratory compromise, rapidly spreading purpura or severe lactate elevation requires simultaneous sepsis and critical-care management.

Papilloedema, unequal pupils, abnormal posture or rapidly deteriorating consciousness makes lumbar puncture unsafe until raised-pressure risk is assessed.

Recent neurosurgery, cerebrospinal fluid shunt, skull-base defect, immunocompromise or travel changes likely organisms and empirical therapy.

Investigation priorities

01
First-line blood culture and systemic profileFirst stepFirst line

Identify the organism and assess inflammation, glucose, perfusion, organ function and coagulation before treatment where possible.

Management branches

First hourStabilise and give antimicrobials

Clinical assessment suggests bacterial meningitis or meningococcal disease.

  1. Use ABCDE, sepsis monitoring, glucose and vascular access while summoning senior help.
  2. Take blood culture and essential tests only if this does not delay antibiotics beyond one hour.
  3. Give age-appropriate empirical intravenous antibiotics and dexamethasone when indicated.

Key medicines

Intravenous ceftriaxoneFor suspected bacterial meningitis beyond the neonatal regimen, a common paediatric dose is 80 mg/kg once daily, maximum 4 g daily, started within one hour and refined by organism, age and the current hospital monograph.Avoid or seek neonatal expertise in premature or jaundiced neonates and with intravenous calcium exposure; review severe beta-lactam allergy, renal or hepatic dysfunction and microbiology results.
Intravenous dexamethasoneFor babies over 3 months and children with strongly suspected or confirmed bacterial meningitis, use 0.15 mg/kg every 6 hours, maximum 10 mg per dose, for 4 days when the organism-based continuation criteria are met.Give with or before the first antibiotic when possible but never delay antibiotics; do not routinely use below 3 months and stop or continue according to organism and specialist advice.
Open full textbook →Answer 2 questions
Sources and review status4 sources · checked 27 Aug 2026 · clinical review pending+
Sources

Sources and review status

National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.

  • NICE NG240 Meningitis GuidelineRecognition, first-hour antibiotics, lumbar puncture, dexamethasone and follow-up.
  • NICE NG143 Fever Under FiveAge-specific serious infection and sepsis recognition.
  • UKHSA Meningococcal Public Health GuidanceNotification, close-contact risk assessment and chemoprophylaxis.
  • NHS Meningitis OverviewSymptoms, emergency action and patient information.

Editorial contact: Doctor’s Passport editorial team. Source-check date is separate from clinical approval. Report a content problem · Content changes

Authoring stateRapid draftClinical stateAwaiting reviewJurisdictionUnited Kingdom