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Pneumococcal meningitis — RACP Paediatrics MCQ

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ModerateIDPneumococcal meningitisRACP Paediatrics

A 4-year-old presents with fever, headache, photophobia, and neck stiffness. CSF shows neutrophilic pleocytosis with low glucose. Gram stain shows gram-positive diplococci. What is the most appropriate treatment?

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Correct answer: C — IV ceftriaxone + IV dexamethasone

Gram-positive diplococci suggest Streptococcus pneumoniae. For suspected pneumococcal meningitis in children >3 months, IV ceftriaxone with adjunctive IV dexamethasone (given before or with the first antibiotic dose) is recommended. Dexamethasone reduces the risk of hearing loss in pneumococcal meningitis.

Reference: Australian Therapeutic Guidelines – 2024 – Antibiotic; RCH Melbourne – 2023 – Meningitis CPG