# Meningitis in Children > Meningitis in children for NEET-PG Paediatrics: age-wise organisms, CSF interpretation, dexamethasone timing, antibiotic duration and TB meningitis. - Canonical URL: https://prepelephant.com/topics/neet-pg/paediatrics/meningitis-in-children - Exam / course: NEET-PG · Subject: Paediatrics - Publisher: PrepElephant (https://prepelephant.com) — Prepared and reviewed by the PrepElephant Academic Review Team - First published: 2026-10-02 - Last updated: 2026-10-02 - How to cite: "Meningitis in Children", PrepElephant, https://prepelephant.com/topics/neet-pg/paediatrics/meningitis-in-children ## Direct answer Fever with a bulging fontanelle, altered sensorium, neck stiffness or a purpuric rash demands a lumbar puncture — the diagnosis of meningitis is cerebrospinal fluid, and the organism list is age-set: Escherichia coli, Klebsiella and group B streptococcus in the neonate; Streptococcus pneumoniae and Neisseria meningitidis from two months to five years; pneumococcus and meningococcus beyond. Typical bacterial fluid is turbid with neutrophils, protein over 100 mg/dL and glucose under 40 per cent of blood; tuberculous meningitis instead shows lymphocytes, very high protein with a cobweb clot and low glucose. Treatment is a third-generation cephalosporin (cefotaxime or ceftriaxone) plus ampicillin in the neonate, with dexamethasone 0.15 mg/kg six-hourly started just before or with the first antibiotic dose. ## What you must remember - **Age-organism grid:** neonate — E. coli, Klebsiella, group B streptococcus, Listeria; two months to five years — pneumococcus, meningococcus, Hib; over five years — pneumococcus and meningococcus; Hib disease has collapsed where conjugate vaccine coverage is high. - **CSF benchmarks:** bacterial — neutrophil predominance, protein often 100-500 mg/dL, glucose below 40 per cent of paired plasma, positive Gram stain and latex agglutination; tuberculous — lymphocytes, protein often above 100-200 mg/dL, very low glucose, cobweb coagulum on standing; viral — lymphocytes, normal-to-mildly-raised protein, normal glucose. - **Antibiotic choices:** neonate — ampicillin plus third-generation cephalosporin (or aminoglycoside); child — ceftriaxone 100 mg/kg/day or cefotaxime 300 mg/kg/day in divided doses; add vancomycin where pneumococcal resistance is possible; suspected meningococcaemia warrants ceftriaxone immediately, before transfer. - **Dexamethasone rule:** 0.15 mg/kg six-hourly for four days, given just before or with the first dose of antibiotic — reduces hearing loss, particularly in Hib and pneumococcal disease; after antibiotics are started its value falls. - **Durations:** meningococcus seven days, Hib seven to ten days, pneumococcus 10-14 days, group B streptococcus and gram-negative neonatal meningitis 14-21 days, with repeat lumbar puncture for gram-negative or non-responding disease. - **Complications to anticipate:** sensorineural hearing loss (universal audiometry at discharge), subdural effusion, hydrocephalus, seizures, syndrome of inappropriate antidiuretic hormone secretion with fluid restriction in the first 48 hours, cerebral herniation from raised pressure, and ventriculitis in neonates. - **Tuberculous meningitis stages (Medical Research Council):** stage 1 non-specific prodrome; stage 2 meningeal signs with cranial nerve palsies; stage 3 coma and decerebrate posturing; basal enhancement and hydrocephalus on imaging, with chest radiograph and contact evidence supporting the diagnosis. - **Prevention quotes:** Hib in the pentavalent vaccine, phased pneumococcal conjugate vaccine under the universal immunisation programme, and chemoprophylaxis of meningococcal contacts with rifampicin or ciprofloxacin. ## How to work through it An eight-month-old with two days of fever, vomiting and increasing irritability now has a full fontanelle and stares blankly. The sequence: secure the airway and circulation, draw blood culture, and perform the lumbar puncture immediately unless contraindicated (herniation signs, instability, coagulopathy, suspected mass) — otherwise antibiotics first, puncture later. Turbid, neutrophil-rich fluid with high protein and low glucose: give dexamethasone with the first antibiotic dose, continue ceftriaxone for 10-14 days on pneumococcal presumption, restrict fluids to two-thirds maintenance for 48 hours, and watch the sodium. Before discharge: hearing assessment, head circumference trend and developmental review. The second case recalibrates the tempo: a three-year-old with three weeks of evening fever and irritability, now with a squint and neck retraction, cerebrospinal fluid showing 80 lymphocytes, protein 180 mg/dL and glucose 18 mg/dL with a cobweb clot. Tuberculous meningitis, stage 2 — start four-drug antitubercular therapy with pyridoxine per national weight-band dosing, add corticosteroids, evaluate contacts under the National Tuberculosis Elimination Programme, and drain hydrocephalus if deteriorating. ## How the exam frames it Two question families recur. First, cerebrospinal fluid interpretation tables turned into prose: candidates lose marks quoting single numbers rather than the pattern, and forget that partially treated bacterial meningitis shifts towards lymphocytes — the reason a lumbar puncture precedes antibiotics whenever safe. Second, the management rules with numbers: dexamethasone dose and its timing relative to the first antibiotic, antibiotic durations by organism, and fluid restriction in the first two days. The Indian angle is tuberculous meningitis — stage at presentation drives outcome, sixth-nerve palsies and basal enhancement are expected answers, and every such child triggers contact screening under the national programme. ## Frequently asked questions ### Which organisms cause meningitis in a one-month-old infant? Escherichia coli, Klebsiella, group B streptococcus and Listeria monocytogenes — treated with ampicillin plus a third-generation cephalosporin such as cefotaxime. ### How does tuberculous meningitis alter the cerebrospinal fluid? Lymphocytic pleocytosis with very high protein, markedly low glucose and a characteristic cobweb coagulum on standing, often with basal enhancement and hydrocephalus on imaging. ### When should dexamethasone be given in bacterial meningitis? Just before or with the first antibiotic dose, 0.15 mg/kg six-hourly for four days — it reduces hearing loss, especially in Haemophilus influenzae type b and pneumococcal infection. ### How long is therapy for pneumococcal meningitis? Ten to 14 days of a third-generation cephalosporin (adding vancomycin where resistance is a concern), versus seven days for meningococcal and up to three weeks for gram-negative neonatal disease. ### Which complication must every survivor be screened for? Sensorineural hearing loss — universal audiometry before or shortly after discharge, because it is the commonest sequela and early detection enables timely hearing rehabilitation.