Emergency Department, Inpatient and ICU Clinical Pathway for Children with Suspected Meningitis Age > 56 Days

Front-line Ordering Clinician (FLOC)/RN Team Assessment
  • Sepsis huddle as clinically indicated
  • History & Physical
  • IV access, Recommended Labs
  • Consider LMX (lidocaine) cream to lower back
  • Consider NPO status for lumbar puncture (LP), imaging
Proceed with LP
Perform LP, send CSF Studies
Unable to obtain CSF
Await results of LP before starting antibiotics
CSF findings consistent
with bacterial meningitis
CSF findings not consistent
with bacterial meningitis
CSF findings consistent
with bacterial meningitis

Interpretation of CSF Results
Typical CSF parameters

Consider other diagnoses
including focal bacterial infection (parameningeal abscess or empyema) and HSV encephalitis
Delay LP
Start Antibiotics,
Perform LP
if/when able
Inpatient Discharge Planning    Consultant Follow-up
Posted: December 2017
Revised: October 2019, January 2021, February 2021, May 2021, September 2021
Authors: S. Sanjeev, MD; K. Chiotos, MD; M. Hayes, Pharm. D; B. Ku, MD; J. Huh, MD; T. Kaur, MD; B. Greywood, MD; J. McGuire MD, MSCE; S. Rosanova, RN; A. Marchegiani, AuD; S. Weiss, MD