From the Guidelines
For meningococcal meningitis, the recommended first-line antibiotic treatment is high-dose intravenous ceftriaxone at 2 grams every 12 hours or cefotaxime at 2 grams every 6 hours, typically continued for 5 days, as indicated by the most recent and highest quality study 1.
Key Considerations
- The choice between ceftriaxone and cefotaxime should be based on local antimicrobial resistance patterns and patient-specific factors, such as renal function and allergy history.
- In patients with severe penicillin allergy, chloramphenicol may be used as an alternative, but its use is less preferred due to potential side effects and lower efficacy compared to cephalosporins.
- Empiric therapy should be started immediately upon suspicion of meningococcal meningitis, even before confirmatory tests return, as delayed treatment significantly increases mortality.
Antibiotic Dosing Regimens
- Ceftriaxone: 2 grams every 12 hours
- Cefotaxime: 2 grams every 6 hours
- Chloramphenicol: 25 mg/kg every 6 hours
Duration of Treatment
- The duration of treatment for meningococcal meningitis is typically 5 days, but may be extended to 10-14 days in certain cases, such as in patients with pneumococcal meningitis or those who are not responding to treatment.
Additional Considerations
- Close contacts of the patient should receive chemoprophylaxis with either rifampin, ciprofloxacin, or ceftriaxone to prevent secondary cases of meningococcal disease.
- The use of adjunctive therapies, such as dexamethasone and therapeutic hypothermia, should be considered on a case-by-case basis, as their benefits and risks are still being studied.
From the FDA Drug Label
For the treatment of meningitis, it is recommended that the initial therapeutic dose be 100 mg/kg (not to exceed 4 grams). Thereafter, a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) is recommended.
Meningitis 40 2 gram Every 8 hours
The recommended antibiotic dosing regimens for meningococcal meningitis are:
- Ceftriaxone: 100 mg/kg (not to exceed 4 grams) as the initial therapeutic dose, followed by a total daily dose of 100 mg/kg/day (not to exceed 4 grams daily) 2
- Meropenem: 40 mg/kg (up to a maximum dose of 2 grams) every 8 hours for pediatric patients 3 months of age and older with normal renal function 3
From the Research
Meningococcal Meningitis Antibiotic Dosing Regimens
- The recommended empiric ceftriaxone dosing regimen for acute bacterial meningitis in adults is 2 g every 12 h 4.
- A single daily dose of ceftriaxone (50 mg/[kg.d]; maximum, 4 g/d) has been used for the treatment of bacterial meningitis in adults, including those with meningococcal meningitis, with a mortality rate of 13% 5.
- Short-term treatment with ceftriaxone 2 g once daily for two days has been compared to a standard regimen of penicillin G for six days in adults with meningococcal meningitis, with comparable clinical and microbiological results 6.
- In pediatric patients, once daily ceftriaxone (80 to 100 mg/kg/day) for 4 days has been shown to be effective and safe for the treatment of meningococcal disease, including meningitis and meningococcemia 7.
- A study in children found that seven days of ceftriaxone therapy is as effective as ten days' treatment for bacterial meningitis, including meningococcal meningitis 8.
Ceftriaxone Dosing Considerations
- A ceftriaxone total daily dose of 2 g may be associated with similar outcomes to a 4 g total daily dose, provided that the causative organism is highly susceptible to ceftriaxone 4.
- The choice of ceftriaxone dosing regimen may depend on the specific clinical situation and the susceptibility of the causative organism 4, 6.
- Careful follow-up of patients receiving ceftriaxone is necessary, particularly in cases of severe meningitis 6.