Acutely unwell child Flashcards
Age > 3 months with suspected bacterial meningitis
IV ceftriaxone for 10 days
Give dexamethasone (0.15 mg/kg to a maximum dose of 10 mg, 4 times daily for 4 days) if lumbar puncture shows signs of bacterial meningitis:
cloudy CSF, WBC > 1000, protein > 1, bacteria on gram stain
do not start dexamethasone more than 12 hours after starting antibiotics
Age < 3 months with suspected bacterial meningitis
IV cefotaxime + amoxicillin/ampicillin for 14 days
DO NOT give corticosteroids
Suspected bacterial meningitis with travel history / exposure to Abx
vancomycin + standard protocol of:
ceftriaxone for age > 3 months
cefotaxime for age < 3 months
Contraindication for ceftriaxone use
calcium-containing infusions –> give cefotaxime as alternative
In age < 3 months, ceftriaxone MAY be used as alternative to cefotaxime. When should this definitely not happen?
ceftriaxone should not be given to premature babies or babies with jaundice, hypoalbuminaemia, acidosis
–> may exacerbate hyperbilirubinaemia
Age > 3 months with H.influenza type b meningitis
IV ceftriaxone for 10 days
Age > 3 months with S.pneumoniae meningitis
IV ceftriaxone for 14 days
Age < 3 months with group B streptococcal meningitis
IV cefotaxime for 14 days
Age < 3 months with L.monocytogenes bacterial meningitis
IV amoxicillin/ampicillin for 21 days + gentamicin for first 7 days
Age < 3 months with gram-negative bacilli bacterial meningitis
IV cefotaxime for 21 days
Confirmed meningococcal disease
IV ceftriaxone for 7 days
Suspected meningococcal disease
IV ceftriaxone for 7 days
What should you assess for in patient with bacterial meningitis?
signs of shock
raised intracranial pressure
signs of dehydration
When should you restrict fluids?
raised ICP
increased ADH secretion –> hyponatraemia
How to treat shock?
give immediate IV fluid bolus 10ml/kg of NaCl 0.9% over 5-10mins
If shock persists, give further 10.
After 40, if shock persists, push another 10, call for anaesthetics for tracheal intubation and mechanical ventilation, administer vasoactive drugs
