Treatment of Meningococcemia
Initiate intravenous ceftriaxone 2 grams every 12 hours (or cefotaxime 2 grams every 6 hours) immediately upon clinical suspicion—do not delay for diagnostic procedures—with a goal of antibiotic administration within 60 minutes of presentation. 1, 2
Immediate Antibiotic Therapy
Administer ceftriaxone 2 grams IV every 12 hours or cefotaxime 2 grams IV every 6 hours as first-line treatment for confirmed or suspected meningococcemia. 1
Benzylpenicillin 2.4 grams IV every 4 hours may be used as an alternative if the organism is confirmed susceptible, though cephalosporins are preferred for empiric therapy. 1
Obtain blood cultures before antibiotics if possible, but never delay treatment to obtain cultures—meningococcemia is a medical emergency requiring immediate intervention. 3, 2, 4
Treatment duration is 5 days for patients who have recovered, though therapy may need extension if clinical response is inadequate. 1
Critical Supportive Care
Implement aggressive fluid resuscitation with 20 mL/kg boluses of isotonic crystalloid up to 60 mL/kg total if signs of shock are present, reassessing after each bolus. 2, 5
Initiate vasopressor support (catecholamines) when fluid resuscitation alone is insufficient to maintain adequate perfusion. 4, 5
Admit all patients with meningococcemia to intensive care for close monitoring and management of potential complications including DIC, multiple organ failure, myocarditis, and respiratory failure. 3, 4
Mechanical ventilation should be initiated promptly for patients with severe cardiorespiratory distress. 4
Infection Control and Chemoprophylaxis
Institute droplet precautions and strict isolation immediately to prevent healthcare worker exposure and secondary transmission. 2
Administer chemoprophylaxis to all close contacts within 24 hours of index case identification—this is the primary prevention strategy for secondary cases in the United States. 1
Close contacts include: household members, childcare center contacts, anyone with direct exposure to oral secretions (kissing, mouth-to-mouth resuscitation, intubation), and airline passengers seated directly next to the patient on flights >8 hours. 1
Acceptable chemoprophylaxis regimens (90-95% effective): rifampin, ciprofloxacin, or ceftriaxone—all are equally acceptable options. 1
If the index patient was treated with antibiotics other than ceftriaxone or third-generation cephalosporins, administer a single 500 mg oral dose of ciprofloxacin before hospital discharge to eradicate nasopharyngeal carriage. 1
Chemoprophylaxis administered >14 days after illness onset in the index patient provides limited or no benefit. 1
Special Considerations for Meningitis Component
If meningococcal meningitis is present or suspected (not just meningococcemia alone), add dexamethasone 0.15 mg/kg IV every 6 hours for 4 days, given with or within 24 hours of the first antibiotic dose. 2
Do NOT use corticosteroids for meningococcemia without meningitis unless inotrope-resistant shock develops. 6
Lumbar puncture should be performed when safe, but never delay antibiotics for imaging or LP—treat first, diagnose later. 2
Common Pitfalls to Avoid
Early symptoms mimic benign viral illness (fever, myalgias, arthralgias, abdominal pain)—maintain high clinical suspicion even without the classic petechial/purpuric rash, as rash may be absent initially or entirely. 3, 4
Most deaths occur within the first 24 hours, making immediate recognition and treatment the most critical determinant of survival. 4
Avoid aggressive fluid resuscitation in isolated meningitis without septic shock, but in meningococcemia with shock, fluids beyond 60 mL/kg plus inotropic support are often required. 2, 5
Oropharyngeal or nasopharyngeal cultures are not helpful for determining chemoprophylaxis needs and unnecessarily delay preventive treatment. 1