One hundred and forty cases of meningitis admitted to the Children's Hospital in Riyadh from June 1980 to the end of May 1982 were included in a prospective study. Sixty-seven percent were under 1 year of age and 90% were under 5 years old. One hundred and twenty-four (88.6%) had purulent CSF, 12 (8.6%) had viral and four (2.9%) had tuberculous meningitis. E. coli was the commonest causative organism in the neonates. After that age S. pneumoniae was the predominant isolate. The implication of increasing resistance of H. influenzae to ampicillin therapy were discussed and a further rare case of meningitis caused by Flavobacterium meningosepticum was described. Seventy-three (52%) were cured completely, 39 (28%) survived with immediate neurological deficits and 28 (20%) died. Mortality and neurological sequelae were found to be high in four categories of patients: neonates, patients who were stuporose or comatose on admission, those who were partially treated before admission and those who presented late after the onset of their symptoms.