What is the treatment for meningococcemia?

Treatment of Meningococcemia

The first-line treatment for meningococcemia is ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours for 5 days in patients who have clinically recovered. 1

Antibiotic Therapy

Initial Empiric Treatment

• First-line options:
  • Ceftriaxone: 2g IV every 12 hours 2, 1
  • Cefotaxime: 2g IV every 6 hours 2, 1

Definitive Treatment (Once N. meningitidis is identified)

• Continue with:
  • Ceftriaxone 2g IV every 12 hours OR
  • Cefotaxime 2g IV every 6 hours 2
• Alternative option:
  • Benzylpenicillin 2.4g IV every 4 hours 2
    • If using benzylpenicillin instead of ceftriaxone, add a single dose of ciprofloxacin 500mg orally to eradicate throat carriage 1
• For severe beta-lactam allergies:
  • Chloramphenicol 25mg/kg IV every 6 hours 2, 1

Duration of Treatment

• 5 days for patients with confirmed meningococcal infection who have clinically recovered 2, 1
• The Journal of Infection guidelines recommend stopping treatment after 5 days if the patient has clinically recovered, while some European guidelines suggest 7 days 1

Management of Complications

For Shock

• Aggressive fluid resuscitation
• Vasopressors if needed
• Monitor for signs of disseminated intravascular coagulation (DIC) 3

For Increased Intracranial Pressure

• Head elevation
• Maintain adequate cerebral perfusion pressure
• Consider neurosurgical consultation for severe cases 4

Adjunctive Therapy

• Dexamethasone 10mg IV every 6 hours should be started with or before the first dose of antibiotics and continued for 4 days in confirmed cases 1
• Routine use of mannitol, acetaminophen, antiepileptic drugs, or hypertonic saline is not recommended 1
• Therapeutic hypothermia and glycerol are contraindicated 1

Antimicrobial Resistance Considerations

• All isolates in U.S. surveillance studies remain susceptible to ceftriaxone 5
• Penicillin resistance is uncommon but increasing, with approximately 10.3% of isolates showing intermediate susceptibility to penicillin G 5
• Ciprofloxacin resistance is emerging in some regions, which may affect prophylaxis choices for close contacts 6, 7

Prophylaxis for Close Contacts

• Options include:
  • Ciprofloxacin (single oral dose) - Note: Consider alternatives in areas with documented ciprofloxacin resistance 6
  • Rifampin (oral administration for 2 days)
  • Ceftriaxone (single intramuscular dose)
  • Azithromycin (in areas with ciprofloxacin resistance) 1, 6

Follow-up and Monitoring

• Monitor clinical response within the first 24-48 hours
• Assess for potential long-term sequelae, both physical and psychological, before discharge
• Perform hearing tests if hearing loss is suspected 1

Common Pitfalls to Avoid

• Delayed antibiotic administration: Meningococcemia is a medical emergency requiring immediate antibiotic therapy
• Inadequate monitoring: Patients can deteriorate rapidly and require intensive care monitoring
• Overlooking close contacts: Failure to provide prophylaxis to close contacts increases risk of secondary cases
• Not considering resistance patterns: While rare, be aware of emerging resistance patterns, particularly with penicillin and ciprofloxacin 5, 7

The centralization of care in specialized units with established protocols has contributed to reduced mortality from meningococcal disease in recent years 4.