Chapter 3.9 Meningitis

Clinical signs

Suspect meningitis if signs of serious bacterial infection (see section 3.8) are present, particularly if any one of the following is present:
The infant:

  • Is drowsy, lethargic or unconscious I convulsing
  • Has a bulging fontanelle
  • Is irritable
  • Has a high-pitched cry.

It is important to attempt lumbar puncture once the infant has been stabilized, ideally within 2 h of initiating antibiotic treatment, because it serves to confirm the diagnosis.


The first-line antibiotics are ampicillin and gentamicin for 3 weeks.

  • Alternatively, give a third-generation cephalosporin, such as ceftriaxone (50 mg/kg every 12 h if < 7 days of age and 75 mg/kg after 1 week) or cefotaxime (50 mg/kg every 12 h if < 7 days or every 6–8 h if > 7 days of age), and gentamicin for 3 weeks.
  • If there are signs of hypoxaemia, give oxygen
  • If the infant is drowsy or unconscious, ensure that hypoglycaemia is not present; if it is, give 2 ml/kg 10% glucose IV.
  • Treat convulsions (after ensuring they are not due to hypoglycaemia or hypoxaemia) with phenobarbital.
  • Make regular checks for hypoglycaemia.