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Am Fam Physician. 2022;105(3):311-312

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Clinical Question

Is it possible to predict the likelihood of bacterial meningitis in children with clinically suspected meningitis?

Evidence Summary

Meningitis is a potentially life-threatening condition characterized by infection or inflammation of the central nervous system. It is classified as bacterial, viral, or aseptic. Delayed or untreated bacterial meningitis is associated with high morbidity and mortality. The incidence of bacterial meningitis in U.S. children ranges from 0.2 to 3.7 cases per 100,000. There is a strong predominance in infants younger than two months,1 likely because of the initiation of Haemophilus influenzae type B and pneumococcal vaccines at two months of age. Because an estimated 11% to 28% of meningitis cases are bacterial,2,3 it is important to accurately distinguish between bacterial and nonbacterial meningitis. Most physicians will perform a lumbar puncture and consider antibiotics for all infants and children with suspected meningitis. Having a clinical prediction rule to determine the need for lumbar puncture and which patients need antibiotics could reduce morbidity and the cost associated with unnecessary procedures and treatment.

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This guide is one in a series that offers evidence-based tools to assist family physicians in improving their decision-making at the point of care.

This series is coordinated by Mark H. Ebell, MD, MS, deputy editor for evidence-based medicine.

A collection of Point-of-Care Guides published in AFP is available at

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