The most important step is to start antibiotics as soon as possible. If a lumbar puncture cannot be done immediately, it is better to start antibiotics before transferring the child to hospital for investigation and further treatment. The sooner the treatment is started the better is the clinical outcome.

1. The first choice of antibiotic is ceftriaxone 100 mg/kg intravenously immediately and then repeatedly daily. In older children the second choice is benzyl penicillin 100 000 units/kg 6 hourly plus chloramphenicol 25 mg/kg 6 hourly intravenously (or intramuscularly if an intravenous line cannot be started). In neonates the second choice is ampicillin and gentamicin.
2. Convulsions should be stopped.
3. Paracetamol and tepid sponging can be used to lower the temperature.
4. Always look for signs of shock and exclude hypoglycaemia.
5. The patient must be transferred urgently to hospital.