Meningococcemia Medication

  • Author: Mahmud H Javid, MBBS; Chief Editor: Burke A Cunha, MD   more...
 
Updated: Oct 26, 2011
 

Medication Summary

Antimicrobial therapy is directed toward treatment of active infection or used prophylactically to protect those exposed to N meningitidis through close contact.

Drugs effective in treating active meningococcal infection include penicillin G, chloramphenicol in patients who are allergic to penicillin, and some cephalosporins (ie, cefotaxime, ceftriaxone, cefuroxime) used to treat pediatric patients. Meningococcal resistance to penicillins has occurred; the mechanism of resistance involves altered penicillin-binding proteins. Sulfonamides have a limited role in meningococcal infections because of the resistance of serogroups A, B, and C; these are not discussed further in this article. The duration of treatment is dictated by clinical response and manifestation of disease, although 10-14 days should be sufficient with a sensitive organism.

Individuals with at least 4 hours of close contact with an index patient during the week before onset of illness are at an increased risk of infection. Individuals at risk include housemates, daycare contacts, cellmates, or individuals exposed to infected nasopharyngeal secretions (eg, through kissing, mouth-to-mouth resuscitation, intubation, suctioning).

Rifampin and ciprofloxacin are commonly used for chemoprophylaxis. Rifampin may eradicate carriage in up to 80-90% of individuals, but resistant strains have occurred.[16] Other agents that can be used include ceftriaxone and azithromycin. A single dose of intramuscular ceftriaxone may be used in children or adults. Vaccination should be adjunctive to antibiotic chemoprophylaxis in susceptible contacts in epidemics.

The 2 types of vaccine available in the United States include the quadrivalent polysaccharide vaccine (MPV4) and the conjugate vaccines (MCV4).[17] In February 2010, the US Food and Drug Administration (FDA) licensed a second quadrivalent conjugate vaccine (Menveo, Novartis Vaccines and Diagnostics)[18] in addition to Menactra, Sanofi Pasteur. A conjugate vaccine against group C (MenC) is available in the United Kingdom and has been used as part of the childhood vaccination schedule since November 1999. Two doses are given at age 3 and 4 months, followed by a booster dose at age 12 months, in which the vaccine is given combined with Hib.[19]

When the MCV4 vaccine was initially approved, it was expected that the immunity produced would last a decade. However, it has been found to wane earlier, and, in October 2010, the Advisory Committee on Immunization Practices (ACIP) recommendations were updated and a booster dose advised after 5 years.[20]

Guillain-Barré syndrome has been associated with its use, and this is a relative contraindication.[21]

The eradication of carriage is also indicated in the index case unless third-generation cephalosporins have been used.

A single intramuscular dose of an oily suspension of chloramphenicol has been shown to be as effective as 5 days of penicillin in persons with meningococcal meningitis, and this may be useful in resource-poor settings.

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Antimicrobial agents

Class Summary

These agents are used to treat active meningococcal infection.

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Penicillin G (Pfizerpen)

 

Treat suspected meningococcal disease with a high dose in the initial 48 h of therapy because meningitis is a likely complication.

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Chloramphenicol (Chloromycetin)

 

Used in patients with penicillin allergy. Chloramphenicol binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. Effective against gram-negative and gram-positive bacteria. Chloramphenicol-resistant strains are found in Southeast Asia but are rare in the United States.

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Ceftriaxone (Rocephin)

 

Third-generation cephalosporin with broad-spectrum gram-negative activity. Lower efficacy against gram-positive organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins.

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Cefotaxime (Claforan)

 

Third-generation cephalosporin with gram-negative spectrum. Lower efficacy against gram-positive organisms. Has been used successfully in pediatric meningococcal meningitis

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Antimicrobial agents, chemoprophylaxis

Class Summary

These agents protect individuals who are at risk because of close contact with patients who have meningitis.

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Rifampin (Rifadin, Rimactane)

 

Semisynthetic derivative of rifamycin B that inhibits bacterial and mycobacterial RNA synthesis by binding to beta-subunit of DNA-dependent RNA polymerase, thus inhibiting binding to DNA and blocking RNA transcription.

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Ciprofloxacin (Cipro)

 

Fluoroquinolone. Inhibits bacterial DNA synthesis and, consequently, growth.

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Ceftriaxone (Rocephin)

 

Third-generation cephalosporin with broad-spectrum gram-negative activity. Lower efficacy against gram-positive organisms. Arrests bacterial growth by binding to 1 or more penicillin-binding proteins. Has successfully treated pediatric meningococcal meningitis. Useful in special circumstances (ie, relatively penicillin-resistant organisms, hypersensitivity reactions to penicillin or chloramphenicol).

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Azithromycin (Zithromax)

 

Semisynthetic antibiotic structurally similar to erythromycin. Inhibits protein synthesis in bacterial cells by binding to 50S subunit of bacterial ribosomes.

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Vaccines

Class Summary

These agents may be used to prevent and control outbreaks of serogroup C meningococcal disease.

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Meningitis group A C Y and W-135 vaccine (Menactra A, C, Y, W-135 diphtheria toxoid conjugate vaccine)

 

Diphtheria toxoid conjugate vaccine induces the production of bactericidal antibodies specific to capsular polysaccharides of serogroups A, C, Y, and W-135.

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Meningococcal vaccine (Menomune A/C/Y/W-135)

 

Quadrivalent vaccine for meningitis prophylaxis. Considered an adjunct to antibiotic chemoprophylaxis.

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Contributor Information and Disclosures
Author

Mahmud H Javid, MBBS  Consultant, Infectious Diseases, Shifa International Hospital, Islamabad, Pakistan

Mahmud H Javid, MBBS is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Coauthor(s)

Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS  Associate Professor of Clinical Medicine, The School of Medicine at Stony Brook University Medical Center; Adjunct Clinical Associate Professor, Department of Medicine, New York College of Osteopathic Medicine of New York Institute of Technology; Attending Physician, Department of Medicine, Division of Infectious Diseases, Director of HIV Prevention Services, Administrative HIV Designee, Nassau University Medical Center

Shadab Hussain Ahmed, MD, FACP, FIDSA, AAHIVS is a member of the following medical societies: American College of Physicians, Infectious Diseases Society of America, and International AIDS Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Mary D Nettleman, MD, MS, MACP  Professor and Chair, Department of Medicine, Michigan State University College of Human Medicine

Mary D Nettleman, MD, MS, MACP is a member of the following medical societies: American College of Physicians, Association of Professors of Medicine, Central Society for Clinical Research, Infectious Diseases Society of America, and Society of General Internal Medicine

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Aaron Glatt, MD  Professor of Clinical Medicine, New York Medical College; President and CEO, Former Chief Medical Officer, Departments of Medicine and Infectious Diseases, St Joseph Hospital (formerly New Island Hospital)

Aaron Glatt, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Medical Association, American Society for Microbiology, American Thoracic Society, American Venereal Disease Association, Infectious Diseases Society of America, International AIDS Society, and Society for Healthcare Epidemiology of America

Disclosure: Nothing to disclose.

Eleftherios Mylonakis, MD  Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital

Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD  Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital

Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America

Disclosure: Nothing to disclose.

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Dorsum of the hand showing a petechial rash. Courtesy of Professor Chien Liu.
Petechial lesions on the palm. Courtesy of Professor Chien Liu.
Petechial rash on lower extremities. Courtesy of Professor Chien Liu.
Conjunctival petechiae. Courtesy of Professor Chien Liu.
Gram-negative intracellular diplococci. Courtesy Professor Chien Liu.
 
 
 
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