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 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
Empirical therapy for suspected meningococcal disease should include an extended-spectrum cephalosporin, such as cefotaxime or ceftriaxone.
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.
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