Bacterial Meningitis Score for Children
Use in patients aged 29 days to 19 years with CSF WBC ≥10 cells/μL. Do not use if patient is critically ill, recently received antibiotics, has a VP shunt or recent neurosurgery, is immunosuppressed, or has other bacterial infection requiring antibiotics (including Lyme disease).
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For patients at very low risk for bacterial meningitis (BMS 0):
- Consider discharge with close follow-up (ideally within 24–48 hours) and return precautions for family, including new seizure activity, altered mental status, purpuric rash, or other concerning symptoms.
- Patients may have received a dose of empiric antibiotics after LP was performed if concern for bacterial meningitis. If no antibiotics were administered, consider a single dose of long-acting antibiotics with good CSF penetration, such as ceftriaxone, prior to discharge.
For patients with at least 1 risk factor for bacterial meningitis or high clinical suspicion (BMS >0):
- Consider admission for parenteral antibiotics and observation while awaiting CSF culture results.
- Make sure CSF is sent for culture.
- Consider continuous monitoring of vital signs and regular neurologic exams.
- If not previously administered, start empiric broad spectrum antibiotics.
- Consider expanding antimicrobial coverage:
- If concern for herpes encephalitis, add acyclovir.
- If high clinical suspicion for tuberculous meningitis, consult with infectious disease specialist and consider rifampin, isoniazid, pyrazinamide, and a fluoroquinolone or aminoglycoside.
- Consider steroid administration based on clinical presentation, geographic area, and potential risk factors.
- Physician gestalt, severity of illness and clinical presentation supersedes the application of the BMS prediction rule.
- If significant suspicion for bacterial meningitis, err on the side of caution and admit for observation and empiric antibiotics.