Meningococcal Meningitis Medication
- Author: Francisco de Assis Aquino Gondim, MD, MSc, PhD; Chief Editor: Karen L Roos, MD more...
Medication Summary
To prevent neurologic damage or death, it is essential to promptly institute empirical therapy with an antibiotic that has effective CNS penetration, is essential when the diagnosis of bacterial meningitis is suspected. Such treatment with should be based on age and underlying disease status, since delay in treatment is associated with adverse clinical outcome.
Antibiotics
Class Summary
Penicillin is the drug of choice for the treatment of meningococcal meningitis and septicemia. Chemoprophylactic antimicrobials most commonly used to eradicate meningococci include rifampin, quinolones (eg, ciprofloxacin), ceftriaxone. Also included in this class are minocycline and spiramycin.
Ciprofloxacin (Cipro)
A single dose (500 mg) of ciprofloxacin may be effective for the eradication of meningococcal carriage in adults. This agent is for chemoprophylaxis only.
Penicillin G (Pfizerpen)
Patients in whom meningococcal disease is suspected should receive a high dose of this drug, which interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.
Ceftriaxone (Rocephin)
This agent is a third-generation cephalosporin with broad-spectrum, gram-negative activity. It has lower efficacy against gram-positive organisms and higher efficacy against resistant organisms.
Rifampin (Rifadin, Rimactane)
Rifampin inhibits DNA-dependent bacteria, but not mammalian, RNA polymerase. This drug is for chemoprophylaxis only.
Chloramphenicol
Chloramphenicol acts by inhibiting bacterial protein synthesis. It binds reversibly to the 50S subunit of bacterial 70S ribosome and prevents attachment of the amino acid–containing end of the aminoacyl-tran to the acceptor site on the ribosome. It is active in vitro against a wide variety of bacteria, including gram-positive, gram-negative, aerobic, and anaerobic organisms. Oily chloramphenicol may be the drug of choice in areas with limited health facilities, because a single dose of the long-acting form has been shown to be effective.
Minocycline (Minocin, Dynacin)
Minocycline is a member of the tetracycline class of antimicrobial agents. It is a broad-spectrum agent that inhibits susceptible organisms by blocking their protein synthesis. Although an oral form of the drug has been approved for chemoprophylactic use to eradicate the meningococcal carrier state, its use for these purposes was associated with a high incidence of general and gastrointestinal symptoms. The use of minocycline should be reserved for situations in which the risk of meningococcal meningitis is high.
Spiramycin
Spiramycin is a macrolide antibiotic that is used as a chemoprophylactic antimicrobial to eradicate meningococci. Spiramycin inhibits the growth of susceptible organisms. It is currently not available in the United States.
Vaccines
Class Summary
Meningococcal vaccines may be used to prevent and control outbreaks of serogroup C meningococcal disease according to CDC guidelines. They induce the formation of bactericidal antibodies to meningococcal antigens. They are used for active immunization against invasive meningococcal disease caused by inclusive serogroups.
Menactra is used for active immunization for persons aged 2-55 years for the prevention of invasive meningococcal disease. Menomune is approved for use in persons of aged 2 years and older. Menveo was approved in 2010 for use in persons aged 11-55 years, and it does not prevent N meningitidis serogroup B infections.
Meningitis group A C Y and W-135 vaccine (Menactra, Menveo, Menomune)
Meningococcal vaccines may be used to prevent and control outbreaks of serogroup C meningococcal disease according to CDC guidelines. They induce the formation of bactericidal antibodies to meningococcal antigens. They are used for active immunization against invasive meningococcal disease caused by inclusive serogroups.
Menactra is used for active immunization for persons aged 9 months-55 years for the prevention of invasive meningococcal disease. Menomune is approved for use in persons of aged 56 years or older. Menveo was approved in 2010 for use in persons aged 2-55 years, and it does not prevent N meningitidis serogroup B infections.
Stephens DS. Neisseria meningitidis. Infect Control. Jan 1985;6(1):37-40. [Medline].
Jackson LA, Schuchat A, Reeves MW, Wenger JD. Serogroup C meningococcal outbreaks in the United States. An emerging threat. JAMA. Feb 1 1995;273(5):383-9. [Medline].
Ahlawat S, Kumar R, Roy P, et al. Meningococcal meningitis outbreak control strategies. J Commun Dis. Dec 2000;32(4):264-74. [Medline].
Kutz JW, Simon LM, Chennupati SK, et al. Clinical predictors for hearing loss in children with bacterial meningitis. Arch Otolaryngol Head Neck Surg. Sep 2006;132(9):941-5. [Medline].
Andersen J, Backer V, Voldsgaard P, et al. Acute meningococcal meningitis: analysis of features of the disease according to the age of 255 patients. Copenhagen Meningitis Study Group. J Infect. May 1997;34(3):227-35. [Medline].
Heckenberg SG, de Gans J, Brouwer MC, Weisfelt M, Piet JR, Spanjaard L, et al. Clinical features, outcome, and meningococcal genotype in 258 adults with meningococcal meningitis: a prospective cohort study. Medicine (Baltimore). 2008;87:185-92. [Medline].
Cuevas LE, Hart CA. Chemoprophylaxis of bacterial meningitis. J Antimicrob Chemother. Feb 1993;31 Suppl B:79-91. [Medline].
Chin RF, Neville BG, Scott RC. Meningitis is a common cause of convulsive status epilepticus with fever. Arch Dis Child. Jan 2005;90(1):66-9. [Medline].
Helmick CG, Bernard KW, D'Angelo LJ. Rocky Mountain spotted fever: clinical, laboratory, and epidemiological features of 262 cases. J Infect Dis. Oct 1984;150(4):480-8. [Medline].
Kotilainen P, Jalava J, Meurman O, et al. Diagnosis of meningococcal meningitis by broad-range bacterial PCR with cerebrospinal fluid. J Clin Microbiol. Aug 1998;36(8):2205-9. [Medline].
Pardo F, Juncal R, Rajo C, Perez del Molino ML. [Usefulness of polymerase chain reaction (PCR) in the diagnosis of meningococcal meningitis]. Enferm Infecc Microbiol Clin. Feb 1999;17(2):74-7. [Medline].
Ni H, Knight AI, Cartwright K, et al. Polymerase chain reaction for diagnosis of meningococcal meningitis. Lancet. Dec 12 1992;340(8833):1432-4. [Medline].
de Filippis I, do Nascimento CR, Clementino MB, et al. Rapid detection of Neisseria meningitidis in cerebrospinal fluid by one-step polymerase chain reaction of the nspA gene. Diagn Microbiol Infect Dis. Feb 2005;51(2):85-90. [Medline].
Talan DA, Guterman JJ, Overturf GD, et al. Analysis of emergency department management of suspected bacterial meningitis. Ann Emerg Med. Aug 1989;18(8):856-62. [Medline].
Shao PL, Chang LY, Hsieh SM, Chang SC, Pan SC, Lu CY, et al. Safety and immunogenicity of a tetravalent polysaccharide vaccine against meningococcal disease. J Formos Med Assoc. Jul 2009;108(7):539-47. [Medline].
Hart CA, Cuevas LE, Marzouk O, et al. Management of bacterial meningitis. J Antimicrob Chemother. Jul 1993;32 Suppl A:49-59. [Medline].
[Guideline] CDC. Updated recommendations for use of meningococcal conjugate vaccines --- Advisory Committee on Immunization Practices (ACIP), 2010. MMWR Morb Mortal Wkly Rep. Jan 28 2011;60(3):72-6. [Medline]. [Full Text].
[Guideline] CDC. Recommendation of the Advisory Committee on Immunization Practices (ACIP) for Use of Quadrivalent Meningococcal Conjugate Vaccine (MenACWY-D) Among Children Aged 9 Through 23 Months at Increased Risk for Invasive Meningococcal Disease. MMWR Morb Mortal Wkly Rep. Oct 14 2011;60:1391-2. [Medline]. [Full Text].
Bhatt KM, Bhatt SM, Mirza NB. Meningococcal meningitis. East Afr Med J. Jan 1996;73(1):35-9. [Medline].
Schwartz B, Al-Tobaiqi A, Al-Ruwais A, et al. Comparative efficacy of ceftriaxone and rifampicin in eradicating pharyngeal carriage of group A Neisseria meningitidis. Lancet. Jun 4 1988;1(8597):1239-42. [Medline].
Print
