In the journal Infectious Diseases in Children, new criteria are presented which allow, based on data on the composition of the cerebrospinal fluid obtained by puncture, and clinical data to exclude bacterial meningitis and avoid an unreasonable prescription of antibiotic therapy in children with clinical signs of bacterial meningitis.

These criteria are based on the results of studies previously carried out by Dutch scientists in which 360 children with a bacterial meningitis clinic participated. According to the new rules, the doctor has the possibility of assessing the risk factors in each case by noting the following syndromes and symptoms: the duration of the disease, the presence of vomiting, the symptoms of irritation of the meninges, the presence of cyanosis, the presence of a petechial rash, altered consciousness and the level of C-reactive squirrel. The clinical risk assessment scale must be calculated for each child and the final indicator can vary from 0.5 to 31 points. Bacterial meningitis is almost always absent with a score below 9.5 (35% of children in this study had a score below 9.5, and subsequently the diagnosis of bacterial meningitis was not confirmed for them) , while with a score greater than 9.5, the risk of the presence of bacterial meningitis is 44%.

In subsequent studies of 227 children with a score greater than 9.5 and with indications of spinal puncture, doctors assessed the diagnostic significance of various cerebrospinal fluid indicators as a criterion for early diagnosis (or for excluding diagnosis ) bacterial meningitis before obtaining the results of a bacteriological study. Total cytosis of cerebrospinal fluid, absolute number of polymorphonuclear leukocytes and C-reactive protein concentration were found to be significantly higher in children with bacterial meningitis than in patients who did not confirm this diagnosis thereafter. However, it should be noted that none of these indicators individually can be a characteristic confirmation of the diagnosis of bacterial meningitis. Researchers have discovered that the absolute number of polymorphonuclear leukocytes and the blood glucose / glucose ratio of cerebrospinal fluid are independent predictors of bacterial meningitis in patients with meningeal symptoms.

In this study, a complete evaluation of the clinical data and an examination of the cerebrospinal fluid made it possible to exclude bacterial meningitis in 30% of the cases and thus avoid the use of irrational therapy.