Key Points
- Prompt diagnosis and treatment of meningococcal disease are important due to risk of severe morbidity and death.
- Empirical therapy for suspected meningococcal disease is an extended-spectrum cephalosporin, such as cefotaxime or ceftriaxone.
- Treatment with penicillin or ampicillin requires susceptibility testing.
- Additional treatment may be needed to eradicate nasopharyngeal carriage.
Diagnosis
The two most common syndromes associated with invasive meningococcal disease are meningitis and septicemia.
Clinical features
Clinical features of meningococcal meningitis include:
- Fever
- Headache
- Stiff neck
Clinical features of meningococcemia include sepsis and rash.
Laboratory testing best practices
Treatment options
Prompt treatment is critical
Extended-spectrum cephalosporins used for empirical therapy
Empirical therapy for suspected meningococcal disease should include an extended-spectrum cephalosporin, such as cefotaxime or ceftriaxone.
Treatment with penicillin or ampicillin requires susceptibility testing
Once the microbiologic diagnosis is established, definitive treatment can be continued with an extended-spectrum cephalosporin (cefotaxime or ceftriaxone). Alternatively, if susceptibility of the meningococcal isolate to penicillin is confirmed, treatment can be switched to penicillin G or ampicillin.
Additional treatment may be needed to eradicate nasopharyngeal carriage
Ceftriaxone clears nasopharyngeal carriage effectively after 1 dose.
If ceftriaxone or cefotaxime aren't used for treatment, one of the following is recommended before hospital discharge to eradicate nasopharyngeal carriage:
- A course of rifampin (4 doses over 2 days)
- A single dose of ciprofloxacin or ceftriaxone