Start empiric therapy ASAP without delay


  • CBC

  • Blood cultures

  • Electrolytes

  • Glucose

  • INR

  • PTT

  • Lumbar puncture

    • If possible prior to antibiotic therapy
    • See below for contraindications

Send CSF for:

  • Gram stain and bacterial culture

  • Cell count and differential

  • Protein

  • Glucose

  • Viral PCR (HSV/VZV, enterovirus, and parechovirus)

  • Additional studies based on history and physical exam

  • Signs increased ICP

  • Coagulopathy

  • Unstable clinical status

  • Overlying skin infection


  • If no LP done, ensure blood cultures done and INITIATE EMPIRIC THERAPY ASAP

  • Consider urgent CT/MRI if concerns of increased ICP prior to LP

  • Obtain CSF as soon as safe to do so