Pediatric Meningococcal Infections Medication

  • Author: Saul N Faust, MA, MBBS, PhD, MRCPCH; Chief Editor: Russell W Steele, MD   more...
 
Updated: May 2, 2011
 

Antibiotics

Class Summary

Mortality in meningococcal infections may be reduced with early antibiotic therapy; however, antibiotics may be less effective in patients with shock or poor tissue perfusion. Regarding community management, because mortality may be reduced with early antibiotic therapy, patients with a meningococcal rash should receive parenteral benzyl penicillin by means of an intravenous or intramuscular route as soon as the diagnosis is suspected. Intramuscular antibiotic injections may be less effective in a patient with shock and poor tissue perfusion. Give cefotaxime, ceftriaxone, or chloramphenicol to patients who are allergic to penicillin.

Empirical antibiotic therapy ensures coverage of likely meningeal pathogens when no rash is present, when the etiology of meningitis is uncertain, and when immediate microbiological diagnosis is unavailable. This approach can be modified in favor of appropriate specific therapy when the organism is identified or when its sensitivities to antibiotics are known. Empirical antibiotic therapy for meningitis based on age is as follows:

  • Neonates - Ampicillin and cefotaxime
  • Infants aged 1-3 months - Ampicillin and cefotaxime with or without vancomycin
  • In older infants, children, and adults - Cefotaxime or ceftriaxone with or without vancomycin
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Penicillin G (Pfizerpen)

 

Preferred agent for initial community management of suspected meningococcal disease.

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Chloramphenicol (Chloromycetin)

 

Can be used in patients with penicillin and cephalosporin allergy.

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Ampicillin (Marcillin, Omnipen, Polycillin, Principen, Totacillin)

 

Used for empiric treatment in neonates aged 0-3 mo to cover possible listeriosis.

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Cefotaxime (Claforan)

 

First-line antibiotic for empiric therapy of meningitis or sepsis while culture and susceptibility data are pending. Cefotaxime or ceftriaxone are the preferred agents for the treatment of confirmed meningococcal disease.

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Ceftriaxone (Rocephin)

 

First-line antibiotic for empiric therapy of meningitis or sepsis while culture and susceptibility data are pending; cefotaxime or ceftriaxone are the preferred agents for the treatment of confirmed meningococcal disease.

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Vancomycin (Lyphocin, Vancocin, Vancoled)

 

Used for empiric management of sepsis and meningitis with risk of resistant pneumococcal infection. Has no activity against gram-negative bacteria, including meningococci.

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Ciprofloxacin (Cipro)

 

Used for chemoprophylaxis of N meningitides infection in adults.

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Rifampin (Rifadin, Rimactane)

 

Used for chemoprophylaxis of N meningitides infection.

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Vasopressors

Class Summary

After basic life support and administration of antibiotics, treating shock is the next priority.

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Dopamine (Intropin)

 

Stimulates adrenergic and dopaminergic receptors; hemodynamic effect depends on dose; Lower doses predominantly stimulate dopaminergic receptors that in turn produce renal and mesenteric vasodilation. Cardiac stimulation and renal vasodilation produced by higher doses. May be given via peripheral cannula prior to obtaining central venous access.

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Dobutamine (Dobutrex)

 

First-line drug in meningococcal sepsis without central venous access; produces vasodilation and increases inotropic state; higher doses may increase heart rate and exacerbate myocardial ischemia; may be given via peripheral cannula prior to central venous access.

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Epinephrine (Adrenaline)

 

For persistent hypotension. Has alpha-agonist effects (eg, increased peripheral vascular resistance, reversed peripheral vasodilatation, systemic hypotension, and vascular permeability) and beta-agonist effects (eg, bronchodilatation, chronotropic cardiac activity, positive inotropic effects).

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Osmotic diuretics

Class Summary

These agents are used to control ICP during elective intubation. These agents raise the osmolality of plasma and renal tubular fluid, which creates an osmotic inhibition of water transport in the proximal tubule. This subsequently decreases the gradient for passive sodium absorption in the ascending limb of the loop of Henle. The increased urinary flow is achieved by a nonelectrolyte solute diuresis. Increases glomerular filtration rate may also be observed.

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Mannitol (Osmitrol)

 

May reduce subarachnoid-space pressure by creating osmotic gradient between CSF in the arachnoid space and plasma; not for long-term use.

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Diuretics

Class Summary

These agents promote excretion of water and electrolytes by the kidneys.

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Furosemide (Lasix)

 

Mechanism for lowering ICP involves lowering cerebral sodium uptake, affecting water transport into astroglial cells by inhibiting cellular membrane cation-chloride pump, and decreasing CSF production by inhibiting carbonic anhydrase; administered after mannitol.

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Glucocorticoids

Class Summary

These agents elicit anti-inflammatory and immunosuppressive properties and cause profound and varied metabolic effects. They modify the body's immune response to diverse stimuli.

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Dexamethasone (Decadron, AK-Dex, Baldex, Dexone)

 

May reduce sensorineural hearing loss in children and infants with H influenzae type B meningitis. Administer to all children with suspected bacterial meningitis (pathophysiology likely to be similar). Does not reduce CNS clearance of bacteria or cause treatment failure.

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Contributor Information and Disclosures
Author

Saul N Faust, MA, MBBS, PhD, MRCPCH  Senior Lecturer in Pediatric Immunology and Infectious Diseases, University of Southampton; Director, Wellcome Trust Clinical Research Facility, Southampton University Hospitals NHS Trust, UK

Saul N Faust, MA, MBBS, PhD, MRCPCH is a member of the following medical societies: British Paediatric Allergy, Immunology and Infectious Group, European Society for Paediatric Infectious Diseases, International Society for Infectious Diseases, and Royal College of Paediatrics and Child Health

Disclosure: Xoma Consulting fee Consulting; GSK Honoraria Consulting; Wyeth travel and registration fee to conference investigator in study being presented at meeting; Sanofi Pasteur Consulting fee Consulting; Pfizer Consulting fee Consulting

Coauthor(s)

Katrina Cathie, BM(Hons), MRCPCH  Academic Clinical Fellow, Southampton University, UK

Katrina Cathie, BM(Hons), MRCPCH is a member of the following medical societies: Royal College of Paediatrics and Child Health

Disclosure: Nothing to disclose.

Michael Levin, PhD, FRCP, FRCPCH  Head, Professor, Imperial College School of Medicine at St Mary's Hospital, Department of Pediatrics, London, England

Disclosure: Nothing to disclose.

Specialty Editor Board

David Jaimovich, MD  Chief Medical Officer, Joint Commission International and Joint Commission Resources

David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Pharmacy Editor, eMedicine

Disclosure: Nothing to disclose.

Joseph Domachowske, MD  Professor of Pediatrics, Microbiology and Immunology, Department of Pediatrics, Division of Infectious Diseases, State University of New York Upstate Medical University

Joseph Domachowske, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Society for Microbiology, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Phi Beta Kappa

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

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Child with severe meningococcal disease and purpura fulminans.
Flowchart shows guidelines for the emergency management of meningococcal disease in children. These guidelines may be reprinted for use in clinical areas and are available at Meningitis.org.
Flowchart shows guidelines for the emergency management of meningococcal disease in adult patients. These guidelines may be reprinted for use in clinical areas and are available from Meningitis.org.
Chart for family practice recognition and management of meningococcal disease (courtesy of Meningitis.org).
Family practice booklet describing management of meningococcal disease in the community (courtesy of Meningitis.org).
 
 
 
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