TABLE 94.5 IMMEDIATE MANAGEMENT STEPS FOR CHILDREN WITH SUSPECTED OR CONFIRMED BACTERIAL MENINGITIS Immediate evaluation Initiate hemodynamic monitoring and support Achieve venous access; use cardiorespiratory monitors Laboratory evaluation Ensure adequate ventilation and cardiac function CSF for cell count and differential; Gram stain and culture; glucose; protein Consider holding CSF in the laboratory for enteroviral or HSV PCR, AFB culture, cryptococcal, or arboviral studies CBC, blood culture, electrolytes, serum glucose, BUN and creatinine, prothrombin time and partial thromboplastin time Medications Fluid resuscitation for septic shock, if present If Mycobacterium tuberculosis or H influenzae type b is the suspected cause of meningitis, consider dexamethasone (0.15 mg/kg) before or with the first dose of antibiotics Antibiotics (see Table 94.7 ) Glucose (if serum glucose