Hospital doctors - paediatrics

Algorithms for Management of Meningococcal Disease and Bacterial Meningitis in Children and Young People for doctors in emergency medicine, Paediatrics, Paediatric Intensive Care Units, Anaesthetics and General Medicine in the UK.

Early management of meningococcal disease in children

Bacterial meningitis and meningococcal disease are foremost among diseases feared by parents and health professionals because of the speed with which they can strike and their devastating consequences.

These algorithms have been written by members of the Guideline Development Group for NICE Bacterial Meningitis and Meningococcal Septicaemia CG102, together with the authors of the original 'Early Management of Meningococcal Disease' St Mary’s / MRF algorithm1,2.  The algorithms were most recently updated in October 2015.

The original St Mary’s/MRF algorithm was based on treating 425 cases of meningococcal disease and on published evidence where possible. It advocated an aggressive approach to management of these critically ill children that has now become standard paediatric life support training. Two UK studies have found that this aggressive approach to treatment of severe cases improves outcome3,4 and research by the Royal College of Paediatrics and Child Health and St Mary’s Hospital, funded by MRF, showed that departures from the management plan set out in the algorithm increased the risk of a fatal outcome5.

The authors have updated the meningococcal disease algorithm to incorporate the NICE guideline, and have developed an accompanying algorithm ‘Management of Bacterial Meningitis in Children and Young People’ based on the NICE guideline. Health professionals can have confidence that these are based on the most exhaustive review of all of the evidence. The algorithms also feature additional ‘How to’ detail for busy doctors, including drugs and dosages for intubation, administration of inotropes and managing raised intracranial pressure.

Since 1999, we have distributed the Early Management Algorithm to all paediatric units and emergency departments in UK hospitals to coincide with the twice yearly intake of new junior doctors. By distributing these new algorithms in partnership with NICE, we hope to give the NICE guideline maximum reach and publicity, and help doctors and nurses save the lives of children and young people.

The algorithms are published by Meningitis Research Foundation and are available free of charge from your local Foundation office or use our online ordering facility for these and other Foundation resources.

These protocols also form part of our resources for doctors in training.

  1. Pollard AJ, Nadel S, Ninis N, Faust SN, Levin M. Emergency management of meningococcal disease: eight years on. Archives of Disease in Childhood. April 2007; 92:283-286.
  2. Pollard AJ, Britto J, Nadel S, DeMunter C, Habibi P, Levin M. Emergency management of meningococcal disease. Archives of Disease in Childhood. March 1999;80:290-296
  3. Booy R, Habibi P, Nadel S, de Munter C, Britto J, Morrison A, Levin M. Reduction in case fatality rate from meningococcal disease associated with improved healthcare delivery. Archives of Disease in Childhood. November 2001;85:386-390.
  4. Thorburn K, Baines P, Thomson A, Hart CA. Mortality in severe meningococcal disease. Archives of Disease in Childhood. November 2001;85:383-385.
  5. Thompson MJ, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L, Harnden A, Mant D, Levin M. Clinical recognition of meningococcal disease in children and adolescents. Lancet. Feb 2006;367(9508):397-403.
Further resources

Bacterial meningitis and meningococcal septicaemia in children - A discharge checklist

For paediatricians in the UK.

This checklist has been developed in consultation with clinicians with many years experience of treating and following up children after bacterial meningitis and septicaemia.

It incorporates NICE CG102 and QS19 and can be filed in the patient’s notes, allowing the clinician to document that recovery information has been relayed to families and appropriate assessment and review procedures have been followed.

England, Wales and Northern Ireland checklist

Scotland checklist