Meningococcemia medical therapy

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [2]; Associate Editor(s)-In-Chief: Cafer Zorkun, M.D., Ph.D. [3]; Ammu Susheela, M.D. [4]

Overview

Meningococcemia is a medical emergency. Breathing support, fluid resucitation, antibiotics like cephalosporin and wound care are the major aspects of treatment.

Medical Therapy

Meningococcemia is a medical emergency. Persons with this type of infection are often admitted to the intensive care unit of the hospital, where they are closely monitored. The person may be placed in respiratory isolation for the first 24 hours to help prevent the spread of the infection to others. Treatments may include:

• Antibiotics given through a vein (IV), given immediately
• Breathing support
• Clotting factors or platelet replacement -- if bleeding disorders develop
• Fluids through a vein (IV)
• Medications to treat low blood pressure
• Wound care for areas of skin with blood clots.
• Meningococcal disease can be treated with a number of effective antibiotics.
• It is important that treatment be started as soon as possible. If meningococcal disease is suspected, antibiotics are given right away. Antibiotic treatment should reduce the risk of dying, but sometimes the infection has caused too much damage to the body for antibiotics to prevent death or serious long-term problems.
• Even with antibiotic treatment, people die in about 10-15% of cases. About 11-19% of survivors will have long-term disabilities, such as loss of limb(s), deafness, nervous system problems, or brain damage.
• Depending on how serious the infection is, other treatments may also be necessary. These can include such things as breathing support, medications to treat low blood pressure, and wound care for parts of the body with damaged skin.

Pharmacotherapy

▸ Click on the following categories to expand treatment regimens.

N. meningitidis   ▸  Penicillin MIC <0.1 μg/mL   ▸  Penicillin MIC ≥0.1 μg/mL Penicillin MIC <0.1 μg/mL Preferred Regimen ▸ Penicillin G 4 MU IV q4h OR ▸ Ampicillin 2 g IV q4h Alternative Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h OR ▸ Chloramphenicol 1—1.5 g IV q6h Penicillin MIC ≥0.1 μg/mL Preferred Regimen ▸ Cefotaxime 2 g IV q4—6h OR ▸ Ceftriaxone 2 g IV q12h Alternative Regimen ▸ Cefepime 2 g IV q8h OR ▸ Chloramphenicol 1—1.5 g IV q6h OR ▸ Moxifloxacin 400 mg IV q24h OR ▸ Meropenem 2 g IV q8h Acute Pharmacotherapies Cephalosporin CSF penetration: cefuroxime 11-14 %; ceftriaxone 1.5-7%, cefotaxime 4-54%, and ceftazidime 14%. Ceftriaxone CSF half life approximately 5 hours. Potential antibiotics include cephalosporins, penicillin, and chloramphenicol. Therapy may be as brief as 10 to 14 days in fully sensitive organisms. Steroid use particularly in purpura fulminans and adrenal hemorrhage (Waterhouse-Friderichsen syndrome) is controversial. Before antibiotics the case fatality rate was over 50%, particularly dangerous in infants and elderly (84% and 72% respectively). Now it is often as low as 8% in major medical centers. References