A 9-month-old infant is brought to the emergency department with high-grade fever for 18 hours, bulging fontanelle, neck stiffness, and a petechial/purpuric rash. Blood culture is sent. What is the FIRST priority intervention?

• A Urgent CT scan of the head before lumbar puncture and antibiotics
• B Lumbar puncture before antibiotics to avoid sterilization of CSF
• C Immediate IV antibiotics (cefotaxime or ceftriaxone) without delay ✓
• D Dexamethasone alone for the first 6 hours to reduce inflammatory meningitis

Explanation

In suspected bacterial meningitis with petechial-purpuric rash (suggesting meningococcaemia — a true emergency), immediate IV antibiotics must be given without waiting for lumbar puncture or CT scan. Blood culture should be collected but antibiotics should not be delayed by even minutes. Lumbar puncture can follow after clinical stabilization, especially if there are no signs of raised ICP. The UK NICE guideline and WHO guidelines both emphasize that antibiotic delay worsens outcomes in purpuric meningococcal disease.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.