Practice Guidelines

Management of bacterial meningitis and meningococcal septicaemia in children and young people: summary of NICE guidance

BMJ 2010; 340 doi: http://dx.doi.org/10.1136/bmj.c3209 (Published 28 June 2010) Cite this as: BMJ 2010;340:c3209
  1. Cristina Visintin, project manager1,
  2. Moira A Mugglestone, director of guideline development1,
  3. Ella J Fields, research fellow1,
  4. Paul Jacklin, senior health economist1,
  5. M Stephen Murphy, clinical co-director (children’s health)1, senior lecturer in paediatrics and child health2, consultant paediatric gastroenterologist3,
  6. Andrew J Pollard, professor of paediatric infection and immunity4
  7. on behalf of the Guideline Development Group
  1. 1National Collaborating Centre for Women’s and Children’s Health, London W1T 2QA
  2. 2College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2TT
  3. 3Birmingham Children’s Hospital, NHS Foundation Trust, Birmingham B4 6NH
  4. 4Department of Paediatrics, University of Oxford, Oxford OX3 9DU
  1. Correspondence to: M A Mugglestone mmugglestone{at}ncc-wch.org.uk

    Bacterial meningitis and meningococcal septicaemia in children and young people are associated with considerable mortality and morbidity. Case fatality rates vary according to the causative organism and the age of the child or young person. In the United Kingdom they range from 2% to 11% and are especially high (about 10%) in neonates (children younger than 28 days). Survivors of bacterial meningitis and meningococcal septicaemia may experience serious long term morbidities (box 1). This article summarises the most recent recommendations from the National Institute for Health and Clinical Excellence (NICE) on the management of bacterial meningitis and meningococcal septicaemia in children and young people aged under 16 years in primary and secondary care.1

    Box 1 Long term morbidities associated with bacterial meningitis and meningococcal septicaemia

    • Hearing loss

    • Orthopaedic complications (damage to bones and joints)

    • Skin complications (including scarring from necrosis)

    • Psychosocial problems

    • Neurological and developmental problems

    • Renal failure

    Recommendations

    NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets.

    Symptoms and signs of bacterial meningitis and meningococcal septicaemia

    • Consider bacterial meningitis and meningococcal septicaemia in children and young people who present with the symptoms and signs in the table. [Based on moderate quality evidence from a meta-analysis of cohort studies, further cohort studies and cross sectional studies, and case series]

    View this table:

    Symptoms and signs of bacterial meningitis and meningococcal septicaemia

    • Some children and young people will present with mostly non-specific symptoms or signs, and the conditions may be difficult to distinguish from other less important (viral) infections. [Based on moderate quality evidence from a meta-analysis of cohort studies, further cohort studies and cross sectional studies, and case series]

    • Be aware that those with more specific symptoms …

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