What are the symptoms and treatment of Neisseria (N.) meningitis in pediatric patients?

From the Guidelines

Neisseria meningitidis infection in pediatric patients presents with fever, headache, neck stiffness, photophobia, altered mental status, irritability, and often a characteristic purpuric rash that doesn't blanch when pressed, as described in the study by 1. Infants may show nonspecific symptoms like poor feeding, lethargy, and bulging fontanelles. The symptoms of Neisseria meningitis in pediatric patients can be summarized as follows:

• Clinical meningitis characterized by fever, lethargy, vomiting, headache, photophobia, neck stiffness, and positive Kernig’s sign and Brudzinski’s sign, as noted in the study by 1
• Petechiae or purpura may also be present
• Infants and young children with meningitis may display less specific features, such as poor feeding, irritability, a high-pitched cry, and a full fontanelle, as described in the study by 1

Treatment requires immediate empiric antibiotics, typically ceftriaxone (50 mg/kg every 12 hours, maximum 2g every 12 hours) or cefotaxime (75 mg/kg every 6-8 hours), as recommended in the study by 1. In penicillin-susceptible cases, penicillin G can be used. Supportive care includes fluid management, seizure control, and monitoring for increased intracranial pressure. Chemoprophylaxis with rifampin, ciprofloxacin, or ceftriaxone should be given to close contacts, as outlined in the study by 1. The disease progresses rapidly, with potential complications including septic shock, disseminated intravascular coagulation, and long-term neurological sequelae. Vaccination against N. meningitidis is recommended for all adolescents and high-risk children to prevent infection, as the bacteria spreads through respiratory droplets and close contact, with a mortality rate of 10-15% even with appropriate treatment. Some key points to consider in the treatment of Neisseria meningitis in pediatric patients include:

• The use of dexamethasone in the treatment of bacterial meningitis, as discussed in the study by 1
• The importance of chemoprophylaxis for close contacts, as outlined in the study by 1
• The need for prompt treatment to prevent long-term neurological sequelae, as noted in the study by 1

From the FDA Drug Label

Meropenem for injection is indicated for the treatment of bacterial meningitis caused by Haemophilus influenzae, Neisseria meningitidis and penicillin-susceptible isolates of Streptococcus pneumoniae. The meropenem for injection dose is 10 mg/kg, 20 mg/kg or 40 mg/kg every 8 hours (maximum dose is 2 grams every 8 hours), depending on the type of infection (cSSSI, cIAI, intra-abdominal infection or meningitis). For pediatric patients weighing over 50 kg administer meropenem for injection at a dose of 500 mg every 8 hours for cSSSI, 1 gram every 8 hours for cIAI and 2 grams every 8 hours for meningitis.

The symptoms of Neisseria meningitis in pediatric patients are not explicitly stated in the provided drug labels. However, the treatment of bacterial meningitis caused by Neisseria meningitidis with meropenem is indicated.

• Treatment: Meropenem for injection is indicated for the treatment of bacterial meningitis caused by Neisseria meningitidis.
• Dosage: The dose of meropenem for injection for pediatric patients is 10 mg/kg, 20 mg/kg or 40 mg/kg every 8 hours, depending on the type of infection.
• Administration: Meropenem for injection should be administered by intravenous infusion over approximately 15 minutes to 30 minutes or as an intravenous bolus injection over approximately 3 minutes to 5 minutes 2.

From the Research

Symptoms of Neisseria Meningitis in Pediatric Patients

• The symptoms of Neisseria meningitis in pediatric patients can be similar to those of viral meningitis and other conditions, making early identification challenging 3.
• Common clinical manifestations include meningitis and invasive meningococcal disease, characterized by high mortality and long-term sequelae 4.
• The infection rate is higher in children younger than 1 year and in adolescents, who are frequently asymptomatic carriers 4.

Treatment of Neisseria Meningitis in Pediatric Patients

• Ceftriaxone or cefotaxime is the preferred drug for bacterial meningitis caused by Neisseria meningitidis, H. influenzae, and pneumococci in pediatric patients 5, 6.
• Ceftriaxone offers an advantage in case of administration since it is administered as a single daily dose 6.
• Appropriate early antibiotic treatment and management for bacterial meningitis is critical for optimal outcomes 3.
• Corticosteroids should be considered in certain cases, although their use is debated 3.

Prevention of Neisseria Meningitis in Pediatric Patients

• Vaccination is the most effective method of preventing infection and transmission of Neisseria meningitis 4, 7.
• Both monovalent meningococcal vaccines (against A, B, and C serotypes) and quadrivalent meningococcal vaccines (against serogroups ACYW) are available and recommended according to local epidemiology 4.
• Increasing vaccine promotion and extending the free offer of the anti-meningococcal B vaccine to teens can help reduce transmission and implement vaccination coverage 4.