NICE clinical guidelines
Issued: June 2010 (last modified: September 2010)
CG102

Bacterial meningitis and meningococcal septicaemia: Management of bacterial meningitis and meningococcal septicaemia in children and young people younger than 16 years in primary and secondary care

This is an extract from the guidance. The complete guidance is available at guidance.nice.org.uk/cg102

Introduction

Bacterial meningitis is an infection of the surface of the brain (meninges) by bacteria that have usually travelled there from mucosal surfaces via the bloodstream. In children and young people aged 3 months or older, the most frequent causes of bacterial meningitis include Neisseria meningitidis (meningococcus), Streptococcus pneumoniae (pneumococcus) and Haemophilus influenzae type b (Hib). These organisms occur normally in the upper respiratory tract and can cause invasive disease when acquired by a susceptible person. In neonates (children younger than 28 days), the most common causative organisms are Streptococcus agalactiae (Group B streptococcus), Escherichia coli, S pneumoniae and Listeria monocytogenes.

Most N meningitidis colonisations are asymptomatic, but occasionally the organism invades the bloodstream to cause disease. Meningococcal disease most commonly presents as bacterial meningitis (15% of cases) or septicaemia (25% of cases), or as a combination of the two syndromes (60% of cases). Meningococcal disease is the leading infectious cause of death in early childhood, making its control a priority for clinical management (as well as public health surveillance and control).

The epidemiology of bacterial meningitis in the UK has changed dramatically in the past two decades following the introduction of vaccines to control Hib, serogroup C meningococcus and some types of pneumococcus. As no vaccine is currently licensed against serogroup B meningococcus, this pathogen is now the most common cause of bacterial meningitis (and septicaemia) in children and young people aged 3 months or older.

This guideline does not consider meningitis associated with tuberculosis (TB), because tuberculous meningitis (or meningeal TB) is covered in Tuberculosis: clinical diagnosis and management of tuberculosis, and measures for its prevention and control (NICE clinical guideline 33). However, some features of the presentation of tuberculous meningitis are indistinguishable from bacterial meningitis.

Under the Health Protection (Notification) Regulations 2010, registered medical practitioners in England have a legal requirement to notify the proper officer of the local authority urgently when they have reasonable grounds for suspecting that a patient has meningitis or meningococcal septicaemia.

Where the evidence supported it, the Guideline Development Group made separate recommendations for the management of different conditions (bacterial meningitis, meningococcal septicaemia, and in some cases, meningococcal disease). Unless otherwise specified, the recommendations refer to all children and young people aged under 16 years. The Guideline Development Group also used the term 'neonate' in some recommendations.

The guideline will assume that prescribers will use a drug's summary of product characteristics (SPC) to inform their decisions for individual patients.