If a baby is in a neonatal unit and meningitis is suspected but the causative pathogen is unknown (for example, because the cerebrospinal fluid Gram stain is uninformative), treat with intravenous amoxicillin and cefotaxime. [2012, amended 2021]
If a baby is in a neonatal unit and meningitis is shown (by either cerebrospinal fluid Gram stain or culture) to be caused by Gram-negative infection, stop amoxicillin and treat with cefotaxime alone. [2012, amended 2021]
If a baby is in a neonatal unit and meningitis is shown (by cerebrospinal fluid Gram stain) to be caused by a Gram-positive bacterium:
continue treatment with intravenous amoxicillin and cefotaxime while waiting for the cerebrospinal fluid culture result and
seek expert microbiological advice. [2012, amended 2021]
If the cerebrospinal fluid culture is positive for group B streptococcus, consider changing the antibiotic treatment to:
benzylpenicillin sodium 50 mg/kg every 12 hours, normally for at least 14 days and
gentamicin, with:
a starting dosage of 5 mg/kg every 36 hours
subsequent doses and intervals adjusted, if necessary, based on clinical judgement (for timing of the second dose, see recommendation 1.20.5 in the section on choice and dosage of intravenous antibiotics for suspected early-onset neonatal infection) and blood gentamicin concentrations (see recommendations 1.35.1 to 1.35.3 in the section on trough concentrations for babies receiving gentamicin)
treatment lasting for 5 days. [2012, amended 2021]
If the blood culture or cerebrospinal fluid culture is positive for listeria, consider stopping cefotaxime and treating with amoxicillin and gentamicin. [2012, amended 2021]
If the cerebrospinal fluid culture identifies a Gram-positive bacterium other than group B streptococcus or listeria, seek expert microbiological advice on management. [2012, amended 2021]
For a short explanation of why the committee amended the 2012 recommendations and how they might affect practice, see the rationale and impact section on antibiotic treatment for early-onset and late-onset meningitis.
Do not routinely restrict fluid intake to below routine maintenance needs in babies with bacterial meningitis. [2024]
Give maintenance fluids orally or by enteral tube, if tolerated. [2024]
For more guidance on fluid therapy, see NICE's guideline on intravenous fluid therapy in children and young people.
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on fluid restriction for confirmed bacterial meningitis.
Full details of the evidence and the committee's discussion are in evidence review M: fluid restriction in bacterial meningitis.
Refer babies with pneumococcal meningitis to a paediatric immunology and infectious disease specialist to assess for primary immunodeficiency. [2024]
For babies with bacterial meningitis, examine their back and scalp for signs of a sinus tract. [2024]
For babies with bacterial meningitis, take a history of:
head trauma, surgery or cerebrospinal fluid leak
immunisations
medicines, including drugs that suppress the immune system (such as complement inhibitors). [2024]
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on assessing for immunodeficiency and recurrence risk in babies with bacterial meningitis.
Full details of the evidence and the committee's discussion are in evidence review N: factors associated with recurrent bacterial meningitis.
After antibiotic treatment, consider prompt discharge of the baby from hospital, with support for the parents and carers and a point of contact for advice. [2012]
See also the section on planning for care after discharge for all babies who have had an infection.
Identify follow-up needs for babies who have had bacterial meningitis, taking into account potential cognitive, neurological, developmental, hearing, psychosocial, education, and renal complications. [2024]
Refer babies for community neurodevelopmental follow-up. [2024]
For babies who are taking anti-epileptic drugs, refer for a medicines review 3 months after hospital discharge, with a clinician with an interest in epilepsy, an epilepsy specialist nurse, or a neurologist. [2024]
Offer an audiological assessment within 4 weeks of the baby being well enough for testing (and preferably before discharge). [2024]
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on preparing for discharge.
Full details of the evidence and the committee's discussion are in evidence review O: long-term complications and follow-up for bacterial meningitis.
Consider referral to psychosocial support for family members and carers of babies who have had bacterial meningitis. [2024]
For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on psychosocial support.
Full details of the evidence and the committee's discussion are in evidence review Q: support for confirmed bacterial meningitis.
For babies who have had bacterial meningitis, arrange for a review with a neonatologist or paediatrician at 4 to 6 weeks after discharge from hospital. As part of this review, cover:
the results of their audiological assessment, and whether cochlear implants are needed
damage to bones and joints
skin complications (including scarring from necrosis)
psychosocial problems (if relevant, see NICE's guideline on post-traumatic stress disorder)
neurological and developmental problems, in liaison with community child development services. [2024]
Arrange a review with a neonatologist or paediatrician for 1 year after discharge. At this review, assess for possible late-onset neurodevelopmental, sensory and psychosocial complications. [2024]
Healthcare professionals (such as school nurses, health visitors and GPs) with responsibility for monitoring the health and wellbeing of babies should be alert for late-onset complications of bacterial meningitis. [2024]
Be aware that late-onset complications may not be apparent until transition points (such as starting nursery or school). [2024]
Community child development services should follow up and assess the risk of long-term neurodevelopmental complications for at least 2 years after discharge. [2024]
If a neurodevelopmental deficit is identified, refer to the appropriate services (for example, neurodisability services) and agree with them who will be responsible for follow-up, to ensure that nobody misses out on care. [2024]
Advise parents and carers to get advice from their GP if their child develops possible neurodevelopmental complications more than 2 years after discharge. [2024]
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on care after hospital discharge.
Full details of the evidence and the committee's discussion are in evidence review O: long-term complications and follow-up for bacterial meningitis and evidence review Q: support for confirmed bacterial meningitis.
Risk factors for recurrent bacterial meningitis are:
primary or secondary immunodeficiency, including:
HIV
congenital complement deficiency or acquired inhibition
reduced or absent spleen function
hypogammaglobulinaemia
communication between the cerebrospinal fluid and external surface, for example, caused by:
prior trauma or surgery
a congenital anomaly. [2024]
For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on risk factors for recurrent bacterial meningitis.
Full details of the evidence and the committee's discussion are in evidence review N: factors associated with recurrent bacterial meningitis.
For babies who have had a recurrent episode of bacterial meningitis:
review with a paediatric immunology and infectious disease specialist and
agree which tests, investigations, vaccines and other interventions are needed to prevent re-occurrence. [2024]
Examine the baby's back and scalp for signs of a sinus tract. [2024]
Get specialist radiological advice on investigations for a cerebrospinal fluid leak. [2024]
Take an immunisation and medicine history, including for drugs that suppress the immune system (such as complement inhibitors). [2024]
In babies with recurrent meningitis with unconfirmed bacterial cause, consider other causes and get advice from an infection specialist. [2024]
For a short explanation of why the committee made these recommendations and how they might affect practice, see the rationale and impact section on managing recurrent bacterial meningitis.
Full details of the evidence and the committee's discussion are in evidence review N: factors associated with recurrent bacterial meningitis.