Bacterial Meningitis Score for Children

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.
• 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.