Clinical Guidance for Meningococcal Disease

Key points

  • Prompt diagnosis and treatment of meningococcal disease are important due to risk of severe morbidity and death.
  • Empiric treatment for suspected meningococcal disease is an extended-spectrum cephalosporin, such as cefotaxime or ceftriaxone.
  • Treatment with penicillin or ampicillin requires susceptibility testing.
  • Maintain awareness that additional treatment may be needed to eradicate nasopharyngeal carriage.
Doctors push a patient laying in a hospital bed

Diagnosis

The two most common syndromes associated with invasive meningococcal disease are meningitis and septicemia.

Clinical features

The most common clinical features of meningococcal meningitis include:

  • Fever
  • Headache
  • Stiff neck

The most common clinical features of meningococcemia include sepsis and rash.

Infants may present with other symptoms:

  • Appear to be slow or inactive
  • Be irritable
  • Feed poorly
  • Have a bulging anterior fontanelle
  • Have abnormal reflexes
  • Vomit

Laboratory testing best practices

Culture and nucleic acid amplification testing (e.g., polymerase chain reaction) have advantages and disadvantages when diagnosing meningococcal disease. Serogroup information informs public health response and helps identify outbreaks.
Read the lab guidance

Treatment options

Prompt treatment is critical

Effective antibiotics should be administered promptly to patients suspected of having meningococcal disease due to risk of severe morbidity and death.

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:

  1. A course of rifampin (4 doses over 2 days)
  2. A single dose of ciprofloxacin or ceftriaxone
For Public Health Chapter 8: Meningococcal Disease

Complications

One in 5 survivors will have long-term disabilities, such as

  • Brain damage
  • Deafness
  • Loss of limb(s)
  • Nervous system problems

About 10 to 15 in 100 people with meningococcal disease will die from this infection.

Resources

Public health strategies for antibiotic-resistant Neisseria meningitidis

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Content Source:
National Center for Immunization and Respiratory Diseases; Division of Bacterial Diseases