The Good Doctor

Category: EXPOSURE

  • Meningococcaemia

    Meningococcaemia

    Have a low threshold to start treatment for a suspected meningitis.

    If meningococcal disease is suspected and unless there is a history of anaphylaxis to penicillins, give Penicillin G (benzylpenicillin) preferentially as an intravenous dose or alternatively as an IMI dose of benzyl or procaine penicillin. Note that IMI antibiotics are given proximally, into a warm part of the limb:

    Benzylpenicillin Dose:

    This is a rule of thumb dosing and, really, for most acute instances, it’s all you need:

    • Infant: 300 mg
    • Child 1-9 years: 600 mg
    • Adult: 1200 mg

    For an undifferentiated meningitis, give a third generation cephalosporin (see below), such as Ceftriaxone or Cefotaxime, preferably intravenously.

    Obtain blood cultures, if possible, prior to giving the antibiotic. But don’t let this concern delay life-saving treatment with antibiotic — you can always collect 2-5 mL blood (EDTA tube), after treatment, for PCR testing.

    EMERGENT DRUG TREATMENT

    1. 50 mg/kg Ceftriaxone or Cefotaxime
    2. 20 mL/kg Normal Saline — if shocked (otherwise, care with fluids as children often have increased ADH secretion)
    3. 0.15 mg/kg Dexamethasone (for undifferentiated meningitis) — within an hour of first antibiotics
    4. Arrange for immediate transfer to hospital

    Alternative antibiotics (IDSA Guidelines):

    • Ampicillin
    • Chloramphenicol 50 mg/kg/day (in two divided doses)
    • Aztreonam
    • Ciprofloxacin (a 500 mg single oral dose is usually reserved for chemoprophylaxis)

    Note: rapid deterioration, without prompt treatment, is the rule

    POST-EMERGENT CARE

    1.  Isolate cases (if possible) until they have had > 12 hours of antibiotic treatment
    2.  Notifiable disease — in Aus., contact Department of Human Services (DHS) Infectious —Disease Unit: Nurse 03 9637 4124, Medical Officer 03 9637 4127
    3.  Contact chemoprophylaxis within 24 hours — usually arranged and supplied by DHS: household, daycare, and intimate contacts exposed to index case within 7 days of onset; any person who gave mouth-to-mouth resuscitation to the index case; index case should also receive prophylaxis if penicillin only was used.
    • Infants and children > 1 month of age: Rifampicin 10 mg/kg PO 12 hourly (max 600 mg) for 2 days
    • Adults: Rifampicin 600 mg 12 hourly for 2 days
    • Infants < 1 month of age: Rifampicin 5 mg/kg PO 12 hourly for 2 days
    • Pregnancy: rifampicin contraindicated; give Ceftriaxone 250 mg STATIM

    Other empirical therapy for an undifferentiated meningitis may include vancomycin and acyclovir. A 7-day course of intravenous ceftriaxone or penicillin is adequate for uncomplicated meningococcal meningitis.

    The course of benzylpenicillin therapy is 200,000-300,000 U/kg/day, divided q2-4hr, x 24 doses.

    References

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