- Low Risk for Bacterial Meningitis:
29-56 days old
Full-term (≥37 weeks gestation)
No prolonged NICU stay
No chronic medical problems
No systemic antibiotics within 72 hours
Well-appearing and easily consolable
No infections on exam - Blood:
WBC ≥ 5,000 and ≤ 15,000
Band to neutrophil ratio < 0.2
(Bands/bands + neutrophils) - Enhanced UA:
WBC < 10 /HPF
Negative Gram stain - Chest x-ray (if obtained):
No infiltrate
All Infants 0-28 Days
All Ill Infants 0-56 Days
Perform LP
Antimicrobials
Admit
Infant 29 to 56 Days
with or without Bronchiolitis
Review Low Risk Criteria, including CBC and enhanced UA (without CSF)
*HIGH RISK
- Perform LP
- Antimicrobials
- Admit
Needs Admission
for Bronchiolitis
LOW RISK
- No antimicrobials
- Discharge
- Assure NP follow-up call
| Antimicrobial Therapy:
(Meningitic doses are used initially-see ED Febrile Infant Order Set) |
| 0-21 days | Ampicillin/Cefotaxime/Acyclovir |
| 22-28 days | Ampicillin/Cefotaxime |
| 29-56 days | Ceftriaxone |
| |
| Additional Considerations: |
| Add Vancomycin | Ill Patient
CSF WBC > 8 w/abnormal glucose or protein
Gram positive organism on Gram stain |
| | |
| Call ID | Gram negative organism on CFS Gram stain
Meropenem and Amikacin |
| | |
HSV
Testing/
Treatment | Start Acyclovir for ALL infants ≤ 21 days and for infants 22 to 40 days with ≥ 1 of the following:
Ill Appearing
Abnormal neurologic status, seizures
Vesicular rash
Hepatitis
Mom known to have primary HSV infection at delivery |
Posted: August 2010
Revised: September 2011, April 2014, October 2014, November 2015, October 2017
Authors: R. Scarfone MD; R. Gala MD; A. Murray MD; MK Funari RN; J. Lavelle MD; L. Bell MD