History
• HA, fever, neck stiffness, lethargy (AMS), N/V, rash, irritability, sz, somnolence
Findings
• Meningismus (stiff neck) occurs <15% of the time in children <18 mo old, petechial rash, irritability/lethargy, hemodynamic instability, fever, sz
Evaluation
• If bacterial etiology suspected, abx should be given immediately, then LP (see 4d)
Treatment
• Dexamethasone 0.15 mg/kg IV before 1st dose of abx (↓ ICP, risk of hearing loss 2/2 H. influenzae)
• Abx
• <1 mo: Ampicillin (100 mg/kg) + gentamicin (2.5 mg/kg) OR cefotaxime (50 mg/kg)
• 1–2 mo: Ampicillin + ceftriaxone (100 mg/kg) OR cefotaxime
• >2 mo: Vancomycin (15 mg/kg) + ceftriaxone OR cefotaxime
• Consider adding acyclovir 20 mg/kg IV
Clinical Pearl
• Ampicillin necessary to cover Listeria in infants