What is the recommended treatment for meningococcal infection?

Treatment of Meningococcal Infection

The recommended first-line treatment for meningococcal infection is intravenous ceftriaxone 2g every 12 hours or cefotaxime 2g every 6 hours for 5 days in patients who have shown clinical improvement. 1

Initial Empiric Treatment

For suspected meningococcal infection before confirmation:

• Adults <60 years: Ceftriaxone 2g IV every 12 hours OR Cefotaxime 2g IV every 6 hours 1
• Adults ≥60 years: Same cephalosporin PLUS Amoxicillin 2g IV every 4 hours (to cover Listeria monocytogenes) 1

Confirmed Meningococcal Infection

Once meningococcal infection is confirmed:

• Continue ceftriaxone 2g IV every 12 hours OR cefotaxime 2g IV every 6 hours 2
• Alternative: Benzylpenicillin 2.4g IV every 4 hours 2
• Treatment duration: 5 days if clinical improvement is observed 2, 1

Antimicrobial Prophylaxis

For patients not treated with ceftriaxone:

• Single dose of ciprofloxacin 500mg orally before discharge 2, 1
• If ciprofloxacin is contraindicated: rifampicin 600mg twice daily for two days 2

Special Considerations

Penicillin-Resistant Strains

• If penicillin resistance is suspected (e.g., patient from region with high resistance rates):
  • Add vancomycin 15-20mg/kg IV every 12 hours (aim for trough levels 15-20μg/mL) OR
  • Add rifampicin 600mg twice daily 2, 1

Outpatient Treatment

• Consider outpatient intravenous therapy for clinically stable patients who have shown initial improvement 2
• Requirements include:
  • Afebrile and clinically improving
  • Reliable IV access
  • No other acute medical needs 1

Management Pitfalls to Avoid

1. Delayed treatment: Meningococcal infection can progress rapidly, requiring immediate antibiotic administration even before confirmatory tests.

2. Inadequate prophylaxis: Failure to provide prophylaxis to patients treated with antibiotics other than ceftriaxone can lead to continued carriage and potential transmission.

3. Insufficient monitoring: Even with appropriate treatment, patients require close monitoring for complications such as shock, DIC, or neurological deterioration.

4. Incomplete treatment course: While 5 days is sufficient for most cases with clinical improvement, premature discontinuation in non-responsive cases can lead to treatment failure.

5. Overlooking resistant strains: In regions with known penicillin resistance, empiric therapy should include appropriate coverage with vancomycin or rifampicin.

The evidence strongly supports cephalosporins (ceftriaxone or cefotaxime) as first-line agents for meningococcal infection due to their excellent CSF penetration and rapid bactericidal activity 3. These agents have largely replaced older treatments due to their superior efficacy and safety profile.

For patients with confirmed meningococcal infection who have recovered by day 5, treatment can be discontinued, as longer courses have not shown additional benefit 2.