Practical approach to bacterial meningitis in childhood.

The classic triad of headache, fever and nuchal rigidity that occurs in adults with bacterial meningitis is often absent in children. Evaluation of the cerebrospinal fluid remains the gold standard for the diagnosis of bacterial meningitis. The choice of antibiotic therapy is dependent on the most likely age-specific pathogen and the drug's bactericidal activity in cerebrospinal fluid. Routine fluid restriction is no longer recommended in the initial management of critically ill patients. Dexamethasone has become an important adjunct to antimicrobial therapy for meningitis due to Haemophilus influenzae type b. Prevention, especially administration of H. influenzae type b vaccine at an early age, is probably the most effective way to reduce the significant mortality and morbidity associated with bacterial meningitis in children.