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Treatment: Meningococcal Infections

  • Initial therapy should focus on urgent clinical issues (e.g., hypovolemic shock, increased intracranial pressure, airway patency) and administration of antibiotics.
  • Empirical antibiotic therapy for suspected meningococcal disease consists of a third-generation cephalosporin such as ceftriaxone (75-100 mg/kg per day [maximum, 4 g/d] in one or two divided IV doses) or cefotaxime (200 mg/kg per day [maximum, 8 g/d] in four divided IV doses) to provide coverage both for meningococci and for other, potentially penicillin-resistant organisms that may produce an indistinguishable clinical syndrome.
  • Meningococcal meningitis and meningococcal septicemia are conventionally treated for 7 days.
    • - A single dose of ceftriaxone has been used successfully in resource-poor settings.
    • - Treatment for meningococcal disease at other foci (e.g., pneumonia, arthritis) is usually continued until clinical and laboratory evidence of infection has resolved; cultures usually become sterile within 24 h of initiation of antibiotics.
  • Little evidence supports other adjunctive therapies (e.g., antibody to lipopolysaccharide, recombinant bactericidal/permeability-increasing protein, activated protein C) in relevant pt populations; these therapies are not currently recommended.

Outline

Section 7. Infectious Diseases