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Guidelines could help predict bacterial meningitis

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New guidelines can help predict the risk of bacterial meningitis for children who have cerebrospinal fluid pleocytosis (CSF) - a greater number of white blood cells than normal, according to a US study.

New guidelines can help predict the risk of bacterial meningitis for children who have cerebrospinal fluid pleocytosis (CSF) - a greater number of white blood cells than normal, according to a US study.

Researchers found that using a clinical prediction rule could reduce unnecessary hospital admissions and prolonged antibiotic use.

The scoring system, known as the 'Bacterial Meningitis Score', classifies patients at very low risk of bacterial meningitis if they lack five criteria. These include certain CSF measurements and a history of seizure.

At present the majority of children with CSF pleocytosis have viral, rather than bacterial meningitis.

But because exclusion of bacterial meningitis requires negative CSF (and blood) cultures after two to three days of incubation, most children are admitted to hospital and receive antibiotics while awaiting culture test results.

The three and a half year study, published today (January 3) in the Journal of the American Medical Association, tracked 3,295 children aged from 29 days to 19 years with CSF pleocytosis. Among these 3.7 per cent had bacterial meningitis and 96.3 per cent had aseptic (non-bacterial) meningitis.

Of the 1,714 patients categorised as very low risk by the Bacterial Meningitis Score, only two had bacterial meningitis. Both patients were younger than two months old.

The authors concluded that using the Bacterial Meningitis Score prediction rule to assist with clinical decision making could 'substantially reduce unnecessary hospital admissions' for children with CSF pleocytosis at very low risk of bacterial meningitis.

Journal of the American Medical Association (2007) 297:52-60

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