What is the treatment for meningococcemia?

From the Guidelines

The treatment for meningococcemia requires immediate administration of antibiotics, with ceftriaxone (2g IV every 12 hours for adults) or cefotaxime (2g IV every 6-hourly) being the first-line options, as recommended by the UK Joint Specialist Societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults 1.

Key Considerations

• The choice of antibiotic should be based on the susceptibility of the meningococcal strain, and ceftriaxone or cefotaxime are preferred due to their broad-spectrum activity and penetration into the cerebrospinal fluid.
• Supportive care is crucial and includes fluid resuscitation, vasopressors for shock, mechanical ventilation if needed, and close monitoring in an intensive care setting.
• Chemoprophylaxis should be given to close contacts using rifampin, ciprofloxacin, or ceftriaxone to prevent secondary cases, with the recommended dose and duration specified in the ESCMID guideline on diagnosis and treatment of acute bacterial meningitis 1.

Chemoprophylaxis

• The recommended dose of prophylactic antibiotic treatment for household contacts and other close contacts of meningococcal meningitis patients is:

• Rifampicin: 600 mg twice a day for 2 days
• Ciprofloxacin: 500 mg oral once
• Ceftriaxone: 250 mg intramuscular once

• Chemoprophylaxis should be administered as soon as possible, ideally within 24 hours after identification of the index patient, to prevent secondary cases 1.

Duration of Treatment

• Treatment typically continues for 7-10 days, but the duration may vary depending on the severity of the disease and the response to treatment.
• For patients with confirmed meningococcal meningitis who have recovered by day 5, treatment can be stopped, as recommended by the UK Joint Specialist Societies guideline 1.

From the FDA Drug Label

Rifampin is not indicated for the treatment of meningococcal infection because of the possibility of the rapid emergence of resistant organisms The FDA drug label does not answer the question.

From the Research

Treatment of Meningococcemia

The treatment of meningococcemia typically involves the use of antibiotics to combat the bacterial infection caused by Neisseria meningitidis.

• The primary goal of treatment is to eradicate the bacteria and prevent further complications, such as shock and raised intracranial pressure 2.
• Several antibiotics have been shown to be effective in treating meningococcemia, including:
  • Ciprofloxacin
  • Rifampin (rifampicin)
  • Minocycline
  • Penicillin
  • Ceftriaxone
• These antibiotics have been found to be effective in eradicating N. meningitidis from the pharynx in healthy carriers, with ciprofloxacin, rifampin, and ceftriaxone being effective for up to two weeks after treatment 3, 4, 5, 6.
• However, the use of rifampin during an outbreak may lead to the circulation of resistant isolates, and therefore, the use of ciprofloxacin, ceftriaxone, or penicillin should be considered 3, 4, 5, 6.
• It is essential to note that prompt recognition of the disease and its complications, as well as rapid administration of parenteral antibiotic treatment, is crucial to reducing the risk of complications and improving outcomes 2.

Antibiotic Effectiveness

The effectiveness of different antibiotics in treating meningococcemia has been studied in several trials, with the following results:

• Ciprofloxacin: effective in eradicating N. meningitidis one week after treatment, with a relative risk (RR) of 0.04; 95% CI 0.01 to 0.12 3, 4, 5, 6.
• Rifampin: effective in eradicating N. meningitidis one week after treatment, with a RR of 0.17; 95% CI 0.12 to 0.24, and still effective at one to two weeks, with a RR of 0.20; 95% CI 0.14 to 0.29 3, 4, 5, 6.
• Minocycline: effective in eradicating N. meningitidis one week after treatment, with a RR of 0.28; 95% CI 0.21 to 0.37 3, 4, 5, 6.
• Penicillin: effective in eradicating N. meningitidis one week after treatment, with a RR of 0.47; 95% CI 0.24 to 0.94, and still effective at one to two weeks, with a RR of 0.63; 95% CI 0.51 to 0.79 5, 6.
• Ceftriaxone: more effective than rifampin after one to two weeks of follow-up, with a RR of 5.93; 95% CI 1.22 to 28.68 3, 4, 5, 6.