Contact: CIM@health.qld.gov.

au
State of Queensland (Queensland Health) 2012
Licensed under: http://creativecommons.org/licenses/by-nc-nd/3.0/au/deed.en
(Affix identification label here)

URN:

Acute Management of Family name:

Suspected Meningococcal Given name(s):
Disease Clinical Pathway Address:

Facility: ......................................................................................................... Date of birth: Sex: M F I

Clinical Pathways never replace clinical judgement. Care outlined in this Pathway must be varied if it is not clinically appropriate for the individual patient.
Signs and Symptoms suggestive of meningococcal disease on presentation may or may not include (tick as appropriate):
Photophobia Neck stiffness Headache Depressed consciousness
Fever Hypotension Petechial non-blanching rash (may not be present)

Early Management Completed Initial Time Date

Move to appropriate resuscitation room
Perform Primary Survey (ABCD)
Document vital signs - temp, HR, RR, BP, SpO2, central capillary refill time
Notify senior medical officer immediately
Gain IV or IO access using aseptic technique
Collect blood for the following tests:
Meningococcal PCR:
PCR: Adult: collect 4mL in a mauve top tube
Child: collect 1mL in a paediatric EDTA pink top tube
Do Not Write in this binding margin

FBC, coagulation tests, LFT, UE, glucose

Collect blood cultures using an aseptic technique
Commence fluid resuscitation as appropriate within 30 minutes
Commence recommended antibiotics within 30 minutes (see table below)
If clinical picture is suggestive of meningitis, follow meningitis flowchart (see
page 2) (note contraindications to a lumbar puncture)
If clinical picture is suggestive of meningococcal sepsis seek senior medical
advice immediately
For retrieval, contact RSQ (Retrieval Services Queensland) 1300 799 127

Meningococcal Disease Clinical Pathway

Notify public health unit (PHU) within 6 hours (see PHU contact details below)
For clinical advice
Child: If facility is level 6 contact ICU or Adult: Contact medical officer at relevant regional or tertiary facility. If
level 5 call RSQ unavailable and pt likely to require retrieval contact RSQ 1300 799 127
Recommended Early Empirical Antibiotic Treatment
Start antibiotic therapy within 30 minutes
This should not be delayed awaiting results of diagnostic tests or fluid resuscitation
Discuss antibiotic choice with senior clinician
Age Group Drug Route Dose / Frequency
Neonates and infants Ampicillin IV 50mg/kg, 6 hourly
plus
less than 3 months cefOTAXIME IV 50mg/kg, 6 hourly

Children 3 months cefTRIAXONE IV 50mg/kg (up to 2g), 12 hourly

or
or more cefOTAXIME IV 50mg/kg (up to 2g), 6 hourly
These recommendations are based on those in
v5.00 - 09/2012

cefTRIAXONE IV 2g, 12 hourly Therapeutic Guidelines: Antibiotic, along with

Adults or recent state and national antibiotic sensitivity
cefOTAXIME IV 2g, 6 hourly profiles of bacterial isolates

Signature Log Every person documenting in this pathway must supply a sample of their initials and signature below
Initials Signature Print Name Role Initials Signature Print Name Role
SW285%

Public Health Unit Phone Numbers Also available at http://www.health.qld.gov.au/publichealthact/notifiable/phucontacts.asp

Business hours only. After hours contact local hospital switchboard and ask for the public health physician on call.
SW285

Brisbane North 3624 1111 Darling Downs 4631 9888 Moreton Bay (Redcliffe) 3142 1800 Townsville 4753 9000
Brisbane South 3000 9148 Gold Coast 5668 3700 Mt Isa & Gulf 4744 9100 West Moreton (Ipswich) 3413 1200
Cairns 4226 5555 Logan 3412 2989 Rockhampton 4920 6989 Wide Bay (Hervey Bay) 4184 1800
Central Queensland 4920 6989 Longreach 4652 6000 South West 4856 8100 Wide Bay (Bundaberg) 4150 2780
(Rockhampton) Mackay 4911 0400 Sunshine Coast 5409 6600
Page 1 of 2
Emergency Management of Children with Meningitis
Child presents to emergency service with clinical features suggesting
meningitis
Assessment
Assess Severity
Consider pre-hospital management given
Stable
Is an LP
contraindicated?*
N region
Can LP be performed
within 30 mins?
Y B Consider ETT intubation if not
Perform LP
Investigation and treatment
Add viral studies depending
on clinical suspicion
Blood cultures
Meningococcal PCR (CSF
+ blood) if meningococcal
disease suspected)
Administer Dexamethasone
plus empirical IV antibiotics
Add IV Acyclovir if
clinical suspicion of HSV
meningoencephalitis#
Review CSF results
Review
Negative
Continue observation in
ED or SSU
Meets discharge
Disposition
criteria?
Y coagulopathy
Discharge
Medications
Dexamethasone (IV)
Acyclovir (IV)
If HSV meningoencephalitis suspected
Clinical features of meningitis (at any age)
Fever Nuchal rigidity
Vomiting and/or nausea (often not present,
Lethargy or irritability especially in young
Photophobia and/or children and infants
headaches Positive Kernig's or
Anorexia Brudzinski's sign
Consider differential diagnoses:
viral encephalitis
intra-cranial collections
eosinophilic meningitis
acute disseminated
encephalomyelitis (ADEM)
"mimics" of meningitis, e.g. other
infectious diseases.
Unstable
*Contraindications for LP: altered level of consciousness or
child unstable
obtundation
altered LOC or obtundation
signs of shock
seizures
coagulopathy
Y suspicion of space occupying
refactory seizures
lesion or ICP
localised infection in the lumbar
Emergency Management
coagulopathy (Resuscitate using ABCD)
Call emergency &/or paediatric
consultant
N
A Provide high-flow oxygen
B Support ventilation (BVM)
responding
Delay LP C Obtain IV or IO access
Within 30 mins of C Give IV fluid boluses 20mL/kg
assessment: 0.9% NaCl as required
Call emergency &/or D Check BSL and give IV 10%
paediatric senior doctor Dextrose (2mL/kg) as required
Blood cultures and if Other treatment:
meningococcal disease Blood cultures
suspected perform Meningococcal PCR (blood) if
meningococcal PCR meningococcal disease suspected
Administer Dexamethasone Administer Dexamethasone plus
plus empirical IV antibiotics empirical IV antibiotics
N Add IV Acyclovir if Add IV Acyclovir if
clinical suspicion of HSV clinical suspicion of HSV
meningoencephalitis# meningoencephalitis#
Is an LP
contraindicated?* Y Improvement?
Positive
*Contraindications for LP:
child unstable
altered LOC or obtundation
Y seizures N
suspicion of space occupying
lesion or ICP
N
localised infection in the lumbar
region
Admit to children's inpatient Arrange transfer to PICU
service (Level 5 call RSQ)
Children 3 months: 0.15mg/kg (up to 10mg), 6 hourly
Neonates: 20mg/kg, 8 hourly
Children: 10mg/kg, 8 hourly
Adults: 10mg/kg, 8 hourly
Additional clinical features of meningitis
Altered mental status in infants less than 3months
Shock Bulging fontanelle High pitched cry
Seizures Poor feeding Apnoea Seizures
Meningeal signs # Consider HSV meningoencephalitis if a history
Focal neurological deficit of maternal HSV infection and predominance of
Petechial rash lymphocytes in the CSF
Reference: Children's Health Services Meningitis
Page 2 of 2 Clinical Procedure Working Group 2011