- If suspected, admit to hospital immediately, call ICU, anaesthesia, and ENT, without distressing the child.

- Keep in position of comfort (usually sitting).

Usual Pathogens

Group A, B, C Streptococci
S. pneumoniae
S. aureus
H. influenzae
H. parainfluenzae
N. meningitidis


Empiric Therapy


Ceftriaxone 50-100mg/kg IV q24h 7-10 days

ß-lactam allergy

Empiric Therapy Dose Duration
Levofloxacin 10-20mg/kg/d IV div q12-24h 7-10 days