What is the treatment for Neisseria meningitidis (N. meningitis) infection?

Treatment of Neisseria meningitidis Infection

For Neisseria meningitidis infection, ceftriaxone 2g IV every 12 hours is the first-line treatment due to its superior CNS penetration and proven efficacy against meningococcal pathogens. 1, 2

Primary Treatment Approach

Initial Therapy

• Ceftriaxone 2g IV every 12 hours should be started immediately upon suspicion of meningococcal infection 1
• Do not delay treatment while awaiting diagnostic confirmation as this increases mortality 1
• A single daily dose of ceftriaxone (80 mg/kg after a loading dose of 100 mg/kg) has also shown efficacy in treating meningococcal meningitis 3

Treatment Duration

• For confirmed meningococcal meningitis with clinical improvement, a 5-day course is sufficient 1
• Ensure the patient is afebrile and clinically improving before considering discontinuation of therapy 1

Adjunctive Therapy

• Dexamethasone 10 mg IV every 6 hours should be started with or before the first dose of antibiotics and continued for 4 days in confirmed cases 1
• Maintain adequate hydration to prevent kidney injury 1

Special Considerations

Eradication of Nasopharyngeal Carriage

• Systemic treatment with ceftriaxone will typically eradicate nasopharyngeal carriage 4
• If other agents were used for treatment that might not reliably eradicate carriage, the patient should receive chemoprophylactic antibiotics before hospital discharge 4

Prophylaxis for Close Contacts

• Close contacts require prophylaxis due to high risk of secondary infection (attack rate 4/1000, which is 500-800 times greater than general population) 4
• Prophylaxis should be administered within 24 hours of identifying the index patient 4
• Options for prophylaxis include:
  • Ciprofloxacin (single oral dose)
  • Ceftriaxone (single intramuscular dose)
  • Rifampin (oral administration for 2 days) 1

Antibiotic Resistance Considerations

• In areas with ciprofloxacin resistance, alternative prophylaxis should be used when:
  1. Two or more invasive meningococcal disease cases caused by ciprofloxacin-resistant strains have been reported in a 12-month period, AND
  2. ≥20% of all reported invasive cases are caused by ciprofloxacin-resistant strains 5
• All isolates in U.S. surveillance studies remain susceptible to ceftriaxone 1

Monitoring and Follow-up

• Monitor clinical response within the first 24-48 hours 1
• If no improvement or clinical deterioration occurs, consider:
  • Repeat lumbar puncture
  • Evaluation for complications
  • Assessment for antibiotic resistance 1
• Assess for potential long-term sequelae, both physical and psychological, before discharge 1
• Perform hearing tests if hearing loss is suspected 1

Common Pitfalls to Avoid

1. Delaying treatment: Never wait for diagnostic confirmation before starting antibiotics, as this significantly increases mortality 1

2. Inadequate dosing: Always use full meningitis dosing (2g IV every 12 hours for adults) 1

3. Neglecting close contacts: Prophylaxis for close contacts is essential and should be administered within 24 hours 4

4. Inappropriate prophylaxis selection: Be aware of local resistance patterns, especially emerging ciprofloxacin resistance 5

5. Insufficient treatment duration: Complete the full 5-day course for meningococcal meningitis even if rapid clinical improvement occurs 1