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 and is the preferred vaccine for aged 56 years or older. Menveo is approved in persons aged 9 months to 55 years. A combination vaccine (MenHibrix) is also available. These vaccines do not prevent N meningitidis serogroup B infections.
In October 2014, the FDA approved the first vaccine for active immunization to prevent invasive meningococcal disease caused by N meningitidis serogroup B in individuals aged 10 through 25 years. [18] A second vaccine for serogroup B was approved in January 2015. [26]
Meningococcal A C Y and W-135 polysaccharide vaccine combined (Menomune A/C/Y/W-135)
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. It is used for active immunization against invasive meningococcal disease caused by inclusive serogroups.
Meningococcal A C Y and W-135 diphtheria conjugate vaccine (Menactra, Menveo)
This vaccine is indicated for children as young as 9 months (Menactra) or 2 months (Menveo) and adults up to 55 years.
Meningococcal C and Y/haemophilus influenza type B vaccine (MenHibrix)
Menhibrix is a combination vaccine approved for use in children as young as 6 weeks old and is indicated to prevent invasive disease caused by Neisseria meningitides serogroups C and Y, and Haemophilus influenzae type b. Menhibrix was newly approved in 2012 and is a 4-dose sequence.
Meningococcal group B vaccine (Trumenba, Bexsero)
The vaccine is administered as a 3-dose series at months 0, 2, and 6 (Trumenba) or a 2-dose series given at least 1 month apart (Bexsero). It induces production of bactericidal antibodies directed against the capsular polysaccharides of serogroup B. It is indicated for active immunization to prevent invasive meningococcal disease caused by Neisseria meningitidis serogroup B in individuals aged 10 through 25 years.
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Head CT demonstrates enlargement of the temporal horns indicating increased intracranial pressure (horizontal open large arrow). The closed arrowhead shows small intracerebral hemorrhage foci on the right temporal lobe, and the curved arrow shows the effect of increased intracranial pressure on the cerebellum.
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Head CT shows small intracerebral hemorrhage foci (vertical closed arrow). Basal ganglia can also not be visualized because of diffuse edema (oblique closed arrow). The black arrow head on the left shows soft tissue edema.
