What is the treatment for Meningococcemia?

Treatment of Meningococcemia

For suspected or confirmed meningococcemia, immediately initiate IV ceftriaxone 2g every 12 hours or cefotaxime 2g every 6 hours, with treatment duration of 5 days for patients who have recovered. 1

Immediate Antibiotic Therapy

• Administer third-generation cephalosporins as first-line treatment: ceftriaxone 2g IV every 12 hours or cefotaxime 2g IV every 6 hours 1
• Benzylpenicillin 2.4g IV every 4 hours is an acceptable alternative for confirmed meningococcal disease 1
• Treatment should be initiated within one hour of clinical suspicion, as delays significantly worsen outcomes 2
• For patients who have recovered by day 5, discontinue antibiotics 1

Critical Supportive Care

• Implement aggressive fluid resuscitation for shock: administer 20 mL/kg boluses of isotonic crystalloid up to 60 mL/kg total, with reassessment after each bolus 3
• Initiate vasopressor support as indicated for refractory hypotension 2
• Admit all patients with meningococcemia and shock to critical care settings immediately 2
• Institute droplet precautions and strict isolation to prevent healthcare worker exposure and secondary transmission 2

Eradication of Nasopharyngeal Carriage

• Patients treated with antibiotics other than ceftriaxone require additional chemoprophylaxis before hospital discharge 1
• Administer a single 500mg oral dose of ciprofloxacin to patients with confirmed or probable meningococcal sepsis who were not treated with ceftriaxone 1
• This prevents persistent nasopharyngeal carriage, as systemic therapy with non-cephalosporin agents does not reliably eradicate N. meningitidis 1

Chemoprophylaxis for Close Contacts

All close contacts must receive chemoprophylaxis regardless of immunization status, ideally within 24 hours of index case identification. 1

Who Requires Chemoprophylaxis:

• Household members 1
• Child-care center contacts 1
• Anyone directly exposed to the patient's oral secretions (kissing, mouth-to-mouth resuscitation, endotracheal intubation) 1
• Passengers with direct respiratory contact or seated directly next to the index patient on flights >8 hours 1

Chemoprophylaxis Regimens (90-95% effective):

• Rifampin, ciprofloxacin, or ceftriaxone are all acceptable options 1
• Chemoprophylaxis administered >14 days after illness onset in the index patient provides limited or no value 1
• Do not obtain oropharyngeal or nasopharyngeal cultures, as they unnecessarily delay prophylaxis without providing useful information 1

Important Clinical Pitfalls

• The attack rate for household contacts is 500-800 times higher than the general population (4 cases per 1,000 exposed), making chemoprophylaxis critical 1
• Healthcare workers exposed to meningococcal patients have a 25-fold increased risk compared to the general population 1
• Early symptoms may mimic benign viral illness, potentially causing dangerous treatment delays 2
• Blood, CSF, and skin biopsy cultures are the gold standard for diagnosis, but treatment must not be delayed awaiting culture results 4

Monitoring and Complications

• Monitor for disseminated intravascular coagulation (DIC), multiple organ failure, and osteonecrosis due to DIC 4
• Manage systemic circulation, respiration, and intracranial pressure aggressively, as these interventions are vital for improving prognosis 4, 5
• Consider outpatient IV therapy for patients who are clinically well and have recovered 1