We report a prospective study of 108 children aged from 2 weeks to 10 years with purulent meningitis admitted to the children's wards of Port Moresby General Hospital, 105 of whom were treated with a standard management regimen using chloramphenicol (given intramuscularly initially) as the only antibiotic. The case fatality rate of 16.7% and the apparently low morbidity rate were felt to be very satisfactory in a high risk population. The medical officers' compliance with the standard antibiotic regimen was good, but was disappointing for the use of anticonvulsants. The presence of convulsions before admission or at any time in the illness, coma on admission, and a history of illness of more than 3 days duration prior to admission were strongly associated with death. We believe phenobarbitone should be given prophylactically to children less than 2 years of age who have meningitis. Further improvements in outcome are likely to be achieved not by changes in antibiotic policy but by improving early diagnosis and basic supportive care, and by preventing convulsions.