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Pediatric meningitis is a serious bacterial infection of the meninges requiring prompt recognition and treatment. Typical symptoms include fever, headache, neck stiffness, and altered mental status. Infants may exhibit only nonspecific signs of infection. Diagnosis relies on analysis of CSF showing pleocytosis with low glucose and elevated protein. Empiric antibiotics like vancomycin and ceftriaxone should be given immediately when bacterial meningitis is suspected clinically. Choice of empiric therapy is based on age-specific likely pathogens. Definitive treatment is tailored to the causative organism once identified by CSF culture. Common pathogens include S. pneumoniae, N. meningitidis, and H. influenzae. Listeria meningitis occurs in neonates and immunocompromised children. Dexamethasone is recommended as adjunctive therapy for pneumococcal meningitis. Sequelae include hearing loss, epilepsy, and cognitive deficits. High rates of morbidity and mortality make prompt recognition and treatment essential. Widespread vaccination against Hib and pneumococcus has reduced the incidence but meningitis remains a serious illness. Clinical pharmacists play a key role in appropriate antibiotic selection and dosing.
In summary, the critical concepts in management of pediatric meningitis include prompt empiric antibiotic therapy to cover major pathogens, tailoring treatment once an organism is identified, selection of antibiotics with good CSF penetration, appropriate duration of treatment to prevent relapse, and utilization of dexamethasone in pneumococcal meningitis. Familiarity with the typical CSF findings, common bacterial pathogens by age, antibiotic options, and prevention through vaccination will prepare pharmacists and clinicians to care for children with this serious CNS infection.
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