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Review of the NICE guidance on bacterial meningitis and meningococcal septicaemia
  1. Ruth H Radcliffe
  1. Department of Paediatrics, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, UK
  1. Correspondence to Ruth H Radcliffe, Department of Paediatrics, Nottingham Children's Hospital, Queens Medical Centre, Nottingham, NG7 2UH, UK; ruthappleyard{at}hotmail.com

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Introduction

Bacterial meningitis still causes significant morbidity and mortality in children and meningococcal disease is the leading cause of infectious death in children in the UK. This article summarises the key recommendations from the National Institute for Health and Clinical Excellence (NICE) guideline1 and highlights areas that may represent a change of practice for some clinicians. Differences between this guideline and the Scottish intercollegiate guideline (SIGN) on meningitis2 (table 1) have been highlighted. The NICE recommendations are shown in italics. The key areas covered by the guideline are described below; however, not all are reviewed within this article.

View this table:
Table 1

Points that differ between guidance in NICE1 and SIGN2 guidelines

The guideline covers

  • Symptoms and signs of bacterial meningitis and meningococcal septicaemia.

  • Management in the prehospital setting.

  • Diagnosis in secondary care.

  • Management in secondary care.

  • Long-term management.

  • Flowcharts for the management of petechial rash, suspected meningococcal disease and bacterial meningitis.

The guideline does not cover

  • Children and young people with known immunodeficiency (primary or secondary).

  • Children and young people with brain tumours, existing hydrocephalus or intracranial shunts.

  • Neonates already receiving care in neonatal units.

How may this guideline change your practice?

  • Using ceftriaxone as first-line treatment for bacterial meningitis and meningococcal disease in children and young people older than 3 months of age (the SIGN guideline recommends cefotaxime).2

  • Not routinely restricting maintenance fluids for children with bacterial meningitis.

  • Reviewing criteria to investigate for immunodeficiency after meningococcal disease.

Important recommendations within the guideline based upon consensus opinion:

  • Children with suspected bacterial meningitis or septicaemia should be transferred to hospital by emergency ambulance.

  • Antibiotic regimens for suspected meningococcal disease and neonatal bacterial meningitis, and antibiotic regimens after bacterial confirmation (based upon epidemiological data, resistance patterns and consensus opinion).

  • Consideration of use of …

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