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This tool supports clinicians caring for children with suspected bacterial meningitis. It gives age-based empiric antibiotics and calculates the Bacterial Meningitis Score for children with CSF pleocytosis, with weight-based doses.
Age comes first. Infants under 1 month get ampicillin plus ceftazidime (or cefepime), and infants 1–2 months get ceftriaxone plus vancomycin. For children 2 months or older, the tool asks whether the child is critically ill, purpuric or has had antibiotics in the last 72 hours; if so, the score does not apply and empiric treatment is advised. It then checks for CSF white cells of 10/µL or more. With pleocytosis, the score adds 2 points for a positive Gram stain and 1 point each for CSF neutrophils 1,000/µL or more, CSF protein 80 mg/dL or more, blood neutrophils 10,000/µL or more, and seizure.
A score of 0 means very low risk, about 0.1%, with outpatient care an option after shared decision-making. A score of 1 or more means admit and treat with ceftriaxone, vancomycin and dexamethasone, plus acyclovir if HSV is possible. It is based on Nigrovic 2007, the 2004 IDSA bacterial meningitis guideline (Tunkel et al.) and the AAP Red Book 2024–2027.
For children with CSF pleocytosis: positive Gram stain scores 2; CSF neutrophils 1,000/µL or more, CSF protein 80 mg/dL or more, blood neutrophils 10,000/µL or more, and seizure at or before presentation each score 1. A score of 0 is very low risk.
It applies only to children 2 months to 18 years with CSF pleocytosis who are not critically ill, not purpuric and have not had antibiotics in the last 72 hours.
For infants under 1 month, the tool gives ampicillin 300 mg/kg/day plus ceftazidime 150 mg/kg/day (or cefepime), adding acyclovir if HSV is a risk. Ceftriaxone is avoided in neonates with jaundice or IV calcium.
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