Empiric antibiotics- don’t delay for LP (have at least 2 hours before LP results are affected by antibiotics) Age Antibiotics 28 days old - Ampicillin- 50 mg/kg IV ≤ - Gentamicin- 2.5 mg/kg IV Cefotaxime (alternative to Gentamicin)- 50 mg/kg IV Workup - Acyclovir- 10mg/kg IV- given if patient has vesicles, neuro changes, seizure, Age Workup thrombocytopenia, high CSF WBC count 28 days dunk” (pleocytosis), no clear guidelines on empiric ≤ “slam old - CBC- WBC and platelet count dosing, talk with your peds consultant - Chem 10- low bicarb = acidosis = sicker patient PEARL- Don’t use ceftriaxone under 28 days or - Cath UA and culture- white cells in the urine, if born prematurely (immature bilirubin nitrite conjugation can cause kernicterus) - Blood culture x1 > 1 month old - Ceftriaxone- 50 mg/kg IV - x-ray Cefotaxime (alternative to Ceftriaxone)- - LP- cell count, glucose and protein, gram stain, 50 mg/kg IV culture - Vancomycin- 20 mg/kg IV PEARL- even if obvious UTI or pneumonia, still need - Over 6 weeks old- consider Decadron full workup (meninges can be seeded from those (dexamethasone) 0.15 mg/kg IV- used to prevent sources) deafness from H Flu meningitis, must be given Antibiotics, admit within 1 hour of antibiotics, no firm guidelines 29 days - 3 A lot of clinicians LP all children under 60 days old - on empiric treatment- talk with your peds mo there are criteria to avoid LP and/or admission consultant (Rochester, Philadelphia, Boston) - Selective workup + or LP – > 3 m.o. UA/UC, can let immunization status and exam be your guide If toxic then full septic workup - Must get catheterized UA and UC All females under 24 months All uncircumcised males under 12 months All circumcised males under 6 months (some guidelines test all boys under 12 months)
Workup Age Workup ≤ 28 days old “slam dunk” - CBC- WBC and platelet count - Chem 10- low bicarb = acidosis = sicker patient - Cath UA and culture- white cells in the urine, nitrite - Blood culture x1 - x-ray - LP- cell count, glucose and protein, gram stain, culture PEARL- even if obvious UTI or pneumonia, still need full workup (meninges can be seeded from those sources) Antibiotics, admit 29 days - 3 mo A lot of clinicians LP all children under 60 days old - there are criteria to avoid LP and/or admission (Rochester, Philadelphia, Boston) - Selective workup + or – LP > 3 m.o. UA/UC, can let immunization status and exam be your guide If toxic then full septic workup - Must get catheterized UA and UC All females under 24 months All uncircumcised males under 12 months All circumcised males under 6 months (some guidelines test all boys under 12 months) Empiric antibiotics- don’t delay for LP (have at least 2 hours before LP results are affected by antibiotics) Age Antibiotics ≤ 28 days old - Ampicillin- 50 mg/kg IV - Gentamicin- 2.5 mg/kg IV Cefotaxime (alternative to Gentamicin)- 50 mg/kg IV - Acyclovir- 10mg/kg IV- given if patient has vesicles, neuro changes, seizure, thrombocytopenia, high CSF WBC count (pleocytosis), no clear guidelines on empiric dosing, talk with your peds consultant PEARL- Don’t use ceftriaxone under 28 days or if born prematurely (immature bilirubin conjugation can cause kernicterus) > 1 month old - Ceftriaxone- 50 mg/kg IV Cefotaxime (alternative to Ceftriaxone)- 50 mg/kg IV - Vancomycin- 20 mg/kg IV - Over 6 weeks old- consider Decadron (dexamethasone) 0.15 mg/kg IV- used to prevent deafness from H Flu meningitis, must be given within 1 hour of antibiotics, no firm guidelines on empiric treatment- talk with your peds consultant