Pathophysiology and Management of Bacterial Meningitis in Pediatrics

Bacterial meningitis in children and infants is correlated with substantial morbidity and mortality. Bacterial meningitis is one of the most frequent central nervous system infections, which is prevalent in low-income countries. There are three types of neonatal meningitis such as early-onset meningitis (from 0–6 days); late-onset meningitis (from 7–29 days) and extremely late-onset meningitis (from 30–90 days). The intense inflammation within the subarachnoid space noted in lumbar cerebrospinal fluid, and the resulting neurological damage, are not the direct result of the pathogenic bacteria but rather of activation of the host’s inflammatory pathways by the microorganisms or their products. All children who are suspected of having meningitis should have their cerebrospinal fluid examined unless lumbar puncture is contraindicated. The critical elements of managing pediatric meningitis involve prompt initiation of therapy, use of the appropriate antimicrobial with correct dosing and duration, attention to expected complications, and appropriate follow-up. In neonates, the primary empiric regimen used conventionally has been ampicillin and gentamycin. For infants whose cerebrospinal fluid is suspicious for bacterial meningitis, ampicillin (300 mg/kg per day divided every 6 hrs) and cefotaxime (200 to 300 mg/kg per day divided every 6 hrs) is appropriate.