A 10-year-old child presents with sudden-onset severe headache, neck stiffness, photophobia, and a petechial/purpuric rash that is non-blanching. Temperature is 39.5°C. What is the IMMEDIATE management priority before lumbar puncture?
- A CT scan of head to rule out raised ICP
- B IV dexamethasone STAT before antibiotics
- C IV ceftriaxone 100 mg/kg STAT ✓
- D Await blood culture results before starting antibiotics
Correct answer: C. IV ceftriaxone 100 mg/kg STAT
Explanation
Non-blanching petechial/purpuric rash with meningism is classic for meningococcal septicemia — a medical emergency. IV ceftriaxone (or benzylpenicillin) should be given IMMEDIATELY without waiting for LP or CT scan, because the purpuric rash indicates possible meningococcaemia with high risk of progression to fulminant septicemia and death within hours. LP can be performed after antibiotics if safe. Dexamethasone is given just BEFORE or with the first antibiotic dose (not instead of it). Blood cultures should be drawn but must not delay antibiotics.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.