History/questionnaire:

< 2 years:

Early non specific features?

- Fever (minority)?

- Irritability?

- Lethargy?

- Altered mental status?

Later features?

- High pitched cry

- Bulging fontanelle

- Neck stiffness

- Haemorrhagic rash (often absent pre-hospital and can be blanching or macular)?

> 2 years and young people:

Early non specific features?

- Fever (common)?

- Irritability?

- Lethargy?

- Altered mental status?

- Muscle and joint aches (uncommon)?

- Nausea and vomiting (common)?

- Respiratory symptoms (common)?

Later features?

- Neck stiffness (uncommon)?

- Headache (uncommon)?

- Photophobia (uncommon)?

- Seizures?

- Haemorrhagic rash - often absent pre-hospital and can be blanching or macular?

Adults:

Early non specific features?

- Fever?

- Irritability?

- Lethargy?

- Altered mental status?

- Muscle and joint aches?

- Nausea and vomiting?

- Respiratory symptoms?

Later features?

- Neck stiffness

- Headache

- Photophobia

- Seizures

- Haemorrhagic rash (often absent pre-hospital and can be blanching or macular)?

- Kernig’s sign?

- Brudzinski’s sign?

Urine output?

Past medical history?

Current medication?

Known drug allergies?

Examination:

Conscious level (eg AVPU scale, Alert, responds to Voice, to Pain, Unresponsive)?

BP (mmHg)?

P (bpm)?

T (°C)?

SpO2 (%)?

CRT (seconds)?

Hydration status?

Management:

Category 2 ambulance called, referral letter written?

As non-blanching rash or signs of meningococcal septicaemia antibiotic given (IV or if vein not available IM as proximal as possible into a warm limb where perfusion will be better)?

- Benzylpenicillin

--- < 1 year: 300 mg?

--- 1-9 years: 600 mg?

--- Adult and child aged 10 or older: 1200 mg

- Cefotaxime (better)

--- < 12 years: 50 mg/kg?

--- ≥ 12 years/adults: 1g?

Safety advice given in children with not clear diagnosis?

Link to PIL ‘Spotting sepsis in children’ from Sepsis Trust given?

Resource(s):

NICE: Meningitis (bacterial) and meningococcal septicaemia in under 16s: recognition, diagnosis and management

CKS: Meningitis - bacterial meningitis and meningococcal disease