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Chapter 120: Meningitis in Infants and Children

Amy Levine

INTRODUCTION AND EPIDEMIOLOGY

Meningitis is an inflammation of the leptomeninges, tissues that cover the brain and spinal cord. Untreated bacterial meningitis has a mortality of nearly 100%, so treat suspected bacterial meningitis promptly. Unfortunately, even with rapid antibiotic treatment, long-term neurologic sequelae occur. Viral meningitis has a range of severity: mild cases resolve without sequelae; however, some viruses, such as herpes virus, can cause severe infections. Meningoencephalitis is an inflammation of the brain as well as the meninges. It is less common than meningitis but can be devastating.

The most common causes of bacterial meningitis vary with the child’s age (Table 120-1). Vaccination programs have had a huge impact on the epidemiology of bacterial meningitis in developed countries. For instance, Haemophilus influenzae vaccine has almost eliminated H. influenzae meningitis in countries where the vaccine is utilized and has decreased overall bacterial meningitis rates by 55%.1 The introduction of the polyvalent vaccinations for Streptococcus pneumoniae (PCV7 in 2000 and PCV13 in 2010) has markedly decreased meningitis caused by that organism, although it remains the most frequent cause of pediatric meningitis.2 Neisseria meningitidis remains an important cause of meningitis in children, and vaccines against serotype B have recently been introduced. Other important causes of bacterial meningitis in children include Mycobacterium tuberculosis and Borrelia burgdorferi, the causative agent of Lyme disease.

TABLE 120-1Causes and Treatment of Bacterial Meningitis by Age Group
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TABLE 120-1 Causes and Treatment of Bacterial Meningitis by Age Group
Age Group Most Common Organisms Treatment Comments
Neonates (0–28 d)

Group B Streptococcus, Escherichia coli

Ampicillin 100 milligrams/kg every 8 h (age <7 d) or 75 milligrams every 6 h (age 7–28 d)

AND

Gentamicin 4 milligrams/kg every 24 h

 Less common organisms: Streptococcus pneumoniae, other gram-negative organisms, Listeria monocytogenes, Haemophilus influenzae type b, Neisseria meningitidis
  Herpes simplex virus type 2 in infected mothers If herpes suspected, add acyclovir 20 milligrams/kg every 8 h  
Young infants (28–90 d) Group B Streptococcus, gram-negative bacilli

Ampicillin 100 milligrams/kg every 6 h

AND

Gentamicin 2.5 milligrams/kg every 8 h

OR

Cefotaxime 100 milligrams/kg every 8 h

 Less common organisms: S. pneumoniae, N. meningitidis
  Herpes simplex virus type 2 If herpes suspected, add acyclovir 20 milligrams/kg every 8 h  
Older infants (>3 months) and children S. pneumoniae, N. meningitidis, H. influenzae type b

Vancomycin 15 milligrams/kg every 6 h

AND

Ceftriaxone* 50 milligrams/kg every 12 h

OR

Cefotaxime† 100 milligrams/kg every 8 h

Approximately half of meningitis in the United States is viral

Immunization makes infection with H. influenzae unlikely in the older infant and child
  Herpes simplex virus type 2

If herpes suspected, add acyclovir 20 milligrams/kg every 8 h

  

*For penicillin/β-lactam allergy, substitute chloramphenicol 50 milligrams/kg every 12 hours.11

†For penicillin/β-lactam allergy, substitute chloramphenicol 25 milligrams/kg every 6 hours.11...

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