What is included in inpatient care of pediatric pneumococcal infections?

Updated: Jan 14, 2019
  • Author: Meera Varman, MD; Chief Editor: Russell W Steele, MD  more...
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ICU admission is initially recommended for all patients with bacterial meningitis.

Consider a second lumbar puncture at 24-48 hours to evaluate therapy if patient is not improving. A repeat lumbar puncture should be performed in all patients with penicillin-resistant pneumococcal meningitis.

If the pneumococcal isolate is found to be susceptible to ceftriaxone (MIC < 0.5), discontinue vancomycin. If the isolate is resistant to ceftriaxone, continue vancomycin and ceftriaxone.

Daily fluid intake and output should be recorded in children with meningitis, and daily electrolyte levels tested during the acute phase of the illness, since children are at risk for syndrome of inappropriate antidiuretic hormone secretion and resultant hyponatremia. Most experts now agree that children with meningitis should receive regular maintenance intravenous or oral fluids rather than fluid restriction, but fluid intake and output still should be recorded carefully.

Children with meningitis should be observed for signs of hydrocephalus. In the young child with an open fontanelle, daily head circumference measurements and palpation of the fontanelle should be performed. Older children should be observed for signs and symptoms of hydrocephalus.

All children with meningitis should undergo hearing tests.

Dexamethasone therapy started prior to antibiotics and administered for 4 days decreased the frequency of hearing loss in children with meningitis caused by Haemophilus influenzae. [11] Smaller studies have documented a decreased frequency of hearing loss in children and adults with pneumococcal meningitis who were treated with dexamethasone. If dexamethasone is given, it should be done prior to the first dose of antibiotics. Dexamethasone dosing is 0.6 mg/kg/d divided every 6 hours for 4 days. However, dexamethasone may decrease CSF concentrations of vancomycin; therefore, use of dexamethasone in regions with a high prevalence of penicillin-resistant pneumococci is controversial.

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