What is the treatment for meningococcemia?

Treatment of Meningococcemia

Initiate parenteral antibiotics immediately upon clinical suspicion of meningococcemia—ideally within 60 minutes of presentation—with ceftriaxone 2 grams IV (or 50-75 mg/kg in children, up to 100 mg/kg for meningitis) plus vancomycin, without waiting for diagnostic confirmation, as delays directly increase mortality in this rapidly progressive infection. 1, 2

Immediate Antibiotic Therapy

• Administer ceftriaxone as the primary agent because it achieves 90-95% effectiveness against N. meningitidis and reliably eradicates nasopharyngeal carriage, unlike other antibiotics 3, 4
• For adults: ceftriaxone 2 grams IV once daily (or 1-2 grams depending on severity) 4
• For children: ceftriaxone 50-75 mg/kg IV for septicemia; increase to 100 mg/kg/day (maximum 4 grams) if meningitis is present 4
• For neonates: administer ceftriaxone over 60 minutes (not 30 minutes) to reduce risk of bilirubin encephalopathy 4
• Add vancomycin empirically until N. meningitidis is confirmed and other pathogens (particularly S. pneumoniae) are excluded 1, 2
• Do not delay antibiotics for blood cultures, lumbar puncture, or imaging—obtain blood cultures if possible, but treatment takes absolute priority 1, 5, 2

Adjunctive Corticosteroid Therapy

• Administer dexamethasone 0.15 mg/kg IV every 6 hours for 4 days when meningitis is suspected or confirmed, given with or within 24 hours of the first antibiotic dose 1
• Do NOT use corticosteroids for meningococcemia without meningitis unless inotrope-resistant shock develops 1

Aggressive Hemodynamic Support

• Implement immediate fluid resuscitation with 20 mL/kg boluses of isotonic crystalloid, reassessing after each bolus, up to 60 mL/kg total if shock is present 1, 2, 6
• Meningococcemia frequently requires fluid volumes exceeding 60 mL/kg plus vasopressor support due to profound distributive shock and capillary leak 1
• Initiate vasopressors early if hypotension persists despite adequate fluid resuscitation 2, 7
• Transfer to intensive care immediately for all patients with meningococcemia, as most deaths occur within the first 24 hours and require mechanical ventilation, inotropic support, and management of DIC 5, 7, 8

Infection Control and Chemoprophylaxis

• Institute droplet precautions immediately upon suspicion to prevent healthcare worker exposure and secondary transmission 2
• Provide chemoprophylaxis to all close contacts within 24 hours of index case identification, as the attack rate for household contacts is 500-800 times higher than the general population 3
• Close contacts include: household members, childcare contacts, anyone with direct oral secretion exposure (kissing, mouth-to-mouth resuscitation, intubation), and airplane passengers seated directly next to the patient on flights >8 hours 3
• Acceptable chemoprophylaxis regimens (all 90-95% effective): rifampin, ciprofloxacin, or ceftriaxone 3
• Chemoprophylaxis administered >14 days after illness onset provides limited or no benefit 3
• The index patient requires chemoprophylaxis before hospital discharge if treated with antibiotics other than ceftriaxone or third-generation cephalosporins, as these may not eradicate nasopharyngeal carriage 3

Treatment Duration and Monitoring

• Continue antibiotics for minimum 7 days for uncomplicated meningococcemia, assuming satisfactory clinical progress 1
• Extend to 14-21 days if meningitis is present 1
• Monitor closely for complications including DIC, multiple organ failure, myocarditis, and peripheral gangrene requiring surgical intervention 5, 7
• Perform repeat lumbar puncture if clinical progress is unsatisfactory 1

Critical Pitfalls to Avoid

• Never delay antibiotics for diagnostic procedures—the time from hospital entry to antibiotic administration must not exceed 60 minutes 1, 2
• Do not use calcium-containing diluents (Ringer's, Hartmann's) with ceftriaxone, as precipitation can occur 4
• Do not rely on the presence of petechial rash or meningeal signs for diagnosis—meningococcemia can present with nonspecific symptoms (fever, myalgias, arthralgias) before the characteristic rash appears 7, 6
• Avoid undertreating shock—meningococcemia causes profound capillary leak and typically requires aggressive resuscitation beyond standard protocols 1, 7