What is the treatment for meningococcemia?

Treatment of Meningococcemia

Immediately administer parenteral third-generation cephalosporin antibiotics (ceftriaxone or cefotaxime) within one hour of clinical suspicion, as prompt antibiotic therapy is the single most critical intervention to reduce mortality in this rapidly progressive, life-threatening infection. 1

Immediate Antibiotic Therapy

• Start empiric antibiotics immediately upon clinical suspicion without waiting for diagnostic confirmation, as delays beyond one hour significantly increase mortality in meningococcemia 1, 2
• Third-generation cephalosporins (ceftriaxone or cefotaxime) are the antibiotics of choice for treating invasive meningococcal disease 3
• Penicillin G is an alternative if meningococcal disease is confirmed and the organism is known to be penicillin-sensitive 2
• For out-of-hospital settings, intramuscular benzylpenicillin should be administered before transport to hospital 3

Critical Timing Consideration

The evidence consistently demonstrates that most deaths from meningococcemia occur within the first 24 hours of presentation, making immediate antibiotic administration without delay for investigations absolutely essential 2, 4

Adjunctive Corticosteroid Therapy

• Administer dexamethasone 0.15 mg/kg IV every 6 hours for 4 days when treating suspected bacterial meningitis of unknown etiology, given with or within 24 hours of the first antibiotic dose 5
• This recommendation applies when meningitis is suspected as part of the meningococcal disease presentation 1

Critical Care Management

Hemodynamic Support

• Implement aggressive fluid resuscitation with 20 mL/kg boluses of isotonic crystalloid, up to 60 mL/kg total, with reassessment after each bolus for patients showing signs of shock 5
• Initiate vasopressor support as indicated for persistent hypotension despite adequate fluid resuscitation 1
• Immediate admission to intensive care is required for patients with meningococcemia and shock 1

Respiratory Support

• Mechanical ventilation should be initiated promptly for patients with severe cardiorespiratory distress, which commonly develops within 24 hours of diagnosis 2

Monitoring for Complications

• Disseminated intravascular coagulation (DIC) requires close monitoring and management 6
• Multiple organ failure is a common complication requiring intensive supportive care 6
• Myocarditis may develop, necessitating ECG monitoring and echocardiography 2
• Peripheral gangrene requiring surgical consultation may occur 2

Infection Control Measures

• Implement droplet precautions and strict isolation immediately upon suspicion to reduce healthcare worker exposure and secondary transmission 1
• Standard precautions including hand hygiene must be maintained 3

Chemoprophylaxis for Close Contacts

All close contacts must receive antibiotic chemoprophylaxis within 24 hours of index case identification, regardless of meningococcal immunization status. 3, 1

Definition of Close Contacts

Close contacts requiring prophylaxis include 3:

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

Prophylaxis Regimens (Choose One)

Ceftriaxone (single dose) 3:

• Child <15 years: 125 mg IM
• Adult: 250 mg IM

Ciprofloxacin (single dose) 3:

• Adult: 500 mg oral

Rifampin (2 days) 3:

• Child <1 month: 5 mg/kg twice daily oral
• Child 1 month-12 years: 10 mg/kg twice daily oral (max 600 mg)
• Adult: 600 mg twice daily oral

Critical Timing for Prophylaxis

• Administer chemoprophylaxis ideally within 24 hours of identifying the index patient, as the attack rate for close contacts is highest immediately after disease onset 3
• Chemoprophylaxis administered >14 days after illness onset in the index patient is of limited or no value 3
• The attack rate for household contacts is 500-800 times greater than the general population (4 cases per 1,000 exposed) 3

Special Consideration for Index Patient

The index patient must receive chemoprophylactic antibiotics before hospital discharge if treated with agents other than ceftriaxone or third-generation cephalosporins, as these other agents may not reliably eradicate nasopharyngeal carriage of N. meningitidis 3

Common Pitfalls to Avoid

• Do not delay antibiotic treatment for lumbar puncture, blood cultures, or other diagnostic tests in patients with suspected meningococcemia and signs of septicemia 3
• Do not rely on oropharyngeal or nasopharyngeal cultures to determine need for chemoprophylaxis in contacts, as this unnecessarily delays prophylaxis 3
• Do not assume early non-specific symptoms (fever, lethargy, myalgias, arthralgias) represent benign viral illness—maintain high index of suspicion as meningococcemia commonly presents with these symptoms before specific features emerge 1, 2
• Do not wait for petechial or purpuric rash to initiate treatment, as not all patients present with rash initially 2