Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management

Introduction

Bacterial meningitis is an infection of the surface of the brain (meninges) by bacteria that have usually travelled there from mucosal surfaces via the bloodstream. In children and young people aged 3 months or older, the most frequent causes of bacterial meningitis include Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib). These organisms occur normally in the upper respiratory tract and can cause invasive disease when acquired by a susceptible person. In neonates (children younger than 28 days), the most common causative organisms are Streptococcus agalactiae (group B streptococcus), Escherichia coli, S pneumoniae and Listeria monocytogenes.

Most N meningitidis colonisations are asymptomatic, but occasionally the organism invades the bloodstream to cause disease. Meningococcal disease most commonly presents as bacterial meningitis (15% of cases) or septicaemia (25% of cases), or as a combination of the 2 syndromes (60% of cases). Meningococcal disease is the leading infectious cause of death in early childhood, making its control a priority for clinical management (as well as public health surveillance and control).

The epidemiology of bacterial meningitis in the UK has changed dramatically in the past 2 decades following the introduction of vaccines to control Hib, serogroup C meningococcus and some types of pneumococcus.

This guideline does not consider meningitis associated with tuberculosis (TB), because tuberculous meningitis (or meningeal TB) is covered in the NICE guideline on tuberculosis. However, some features of the presentation of tuberculous meningitis are indistinguishable from bacterial meningitis.

Under the Health Protection (Notification) Regulations 2010, registered medical practitioners in England have a legal requirement to notify the proper officer of the local authority urgently when they have reasonable grounds for suspecting that a patient has meningitis or meningococcal septicaemia.

Where the evidence supported it, the guideline development group made separate recommendations for the management of different conditions (bacterial meningitis, meningococcal septicaemia, and in some cases, meningococcal disease). Unless otherwise specified, the recommendations refer to all children and young people aged under 16 years. The guideline development group also used the term 'neonate' in some recommendations.

The guideline will assume that prescribers will use a drug's summary of product characteristics to inform their decisions for individual patients.