Meningococcemia Medication

Updated: Oct 12, 2017
  • Author: Mahmud H Javid, MBBS; Chief Editor: John L Brusch, MD, FACP  more...
  • Print
Medication

Medication Summary

Antimicrobial therapy is directed toward treatment of active infection or is used prophylactically to protect persons exposed to N meningitidis through close contact. Most patients with uncomplicated meningococcemia defervesce within the first 24 hours of antibiotic therapy.

Drugs effective in treating active meningococcal infection include penicillin G, chloramphenicol in patients who are allergic to penicillin, and some cephalosporins (ie, cefotaxime, ceftriaxone) used to treat pediatric patients. Meningococcal resistance to penicillins has occurred; the mechanism of resistance involves altered penicillin-binding proteins.

The duration of antimicrobial treatment is dictated by clinical response and the manifestation of the 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 for 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. [94] 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 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.

Next:

Antimicrobial agents

Class Summary

Empiric antimicrobial therapy must be comprehensive and should cover all likely pathogens in the context of the clinical setting. People who come into household contact with patients who have meningococcal disease are at risk of acquiring this illness. Person-to-person transmission can be interrupted by chemoprophylaxis, which eradicates the asymptomatic nasopharyngeal carrier state. Rifampin, quinolones, and sulfonamides are the antimicrobials used to eradicate meningococci from the nasopharynx.

Mortality in meningococcal infections may be reduced with early antibiotic therapy. 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 IV or IM route as soon as the diagnosis is suspected. IM 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. Empiric antibiotic therapy for meningitis based on age is as follows:

- Neonates - Ampicillin and cefotaxime

- Infants aged 1-3 months - Ampicillin and cefotaxime

- Older infants, children, and adults - Cefotaxime or ceftriaxone

Meropenem (Merrem IV)

Meropenem is a bactericidal broad-spectrum carbapenem antibiotic that inhibits cell-wall synthesis. It is effective against most gram-positive and gram-negative bacteria. Meropenem has slightly increased activity against gram-negatives and slightly decreased activity against staphylococcal and streptococcal organisms compared with imipenem.

Penicillin G (Pfizerpen-G)

Penicillin G interferes with synthesis of cell wall mucopeptide during active multiplication, resulting in bactericidal activity against susceptible microorganisms.

Treat suspected meningococcal disease with a high dose in the initial 48 hours of therapy because meningitis is a likely complication. This is the preferred agent for the initial community management of suspected meningococcal disease.

Infections caused by organisms classified as relatively resistant to penicillin, based on a minimum inhibitory concentration (MIC) of 0.1-1 µg/mL of penicillin, seem to respond to this drug as well as fully susceptible organisms do.

Chloramphenicol

Chloramphenicol can be used in patients with penicillin and cephalosporin allergies. It binds to 50S bacterial-ribosomal subunits and inhibits bacterial growth by inhibiting protein synthesis. It is effective against gram-negative and gram-positive bacteria. Chloramphenicol-resistant strains are found in Southeast Asia but are rare in the United States.

Ceftriaxone (Rocephin)

Ceftriaxone is a third-generation cephalosporin with broad-spectrum, gram-negative activity. It has lower efficacy against gram-positive organisms. Ceftriaxone arrests bacterial growth by binding to 1 or more penicillin-binding proteins. It has successfully been used to treat pediatric meningococcal meningitis. It is useful in special circumstances (ie, relatively penicillin-resistant organisms, hypersensitivity reactions to penicillin or chloramphenicol).

Ceftriaxone is a 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.

Cefotaxime (Claforan)

Cefotaxime is a third-generation cephalosporin with a gram-negative spectrum. It has lower efficacy against gram-positive organisms. Cefotaxime has been used successfully in pediatric meningococcal meningitis

The drug is more expensive than penicillin, but most authorities believe that it is as efficacious as penicillin in the treatment of meningococcal disease.

Cefotaxime arrests bacterial cell wall synthesis, which, in turn, inhibits bacterial growth. It is used for penicillin-resistant strains.

Cefotaxime is used as a first-line antibiotic for the 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.

Ampicillin

Ampicillin is used for the empiric treatment in neonates aged 0-3 months to cover possible listeriosis.

Rifampin (Rifadin)

Rifampin is a semisynthetic derivative of rifamycin B that inhibits bacterial and mycobacterial RNA synthesis by binding to the beta subunit of deoxyribonucleic acid (DNA)–dependent RNA polymerase, thus inhibiting binding to DNA and blocking RNA transcription.

Rifampin is commonly used for meningococcal prophylaxis of household contacts in United States, where one third of prevalent strains are sulfadiazine resistant.

Ciprofloxacin (Cipro)

Ciprofloxacin is a fluoroquinolone. It inhibits bacterial DNA synthesis and, consequently, growth. A single dose of 500mg has been found to provide an effective alternative to rifampin for the eradication of meningococcal carriage in adults. Ciprofloxacin is commonly used for meningococcal prophylaxis. It is not recommended for persons younger than 18 years because it has caused cartilage damage in immature experimental animals. Resistance has been reported, and it should only be used if the strain is known to be susceptible.

Azithromycin (Zithromax, Zmax)

Azithromycin is a semisynthetic antibiotic that is structurally similar to erythromycin. It inhibits protein synthesis in bacterial cells by binding to the 50S subunit of bacterial ribosomes.

Previous
Next:

Inotropic Agents

Class Summary

These agents are used to support circulation in patients with shock.

Dopamine

Stimulates adrenergic and dopaminergic receptors. Its hemodynamic effect is dependent on the dose. Lower doses predominantly stimulate dopaminergic receptors that, in turn, produce renal and mesenteric vasodilation. Cardiac stimulation and renal vasodilation are produced by higher doses. After initiating therapy, increase the dose by 1-4 mcg/kg/min every 10-30 minutes until the optimal response is obtained. More than 50% of patients are satisfactorily maintained on doses less than 20 mcg/kg/min.

Dobutamine

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

Epinephrine (Adrenalin)

Epinephrine is used for persistent hypotension. It 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).

Previous
Next:

Diuretics, Osmotic Agents

Class Summary

These agents are used to control ICP during elective intubation. Osmotic diuretics 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 nonelectrolyte solute diuresis. Increases in the glomerular filtration rate may also be observed.

Mannitol (Osmitrol, Aridol)

Mannitol may reduce subarachnoid-space pressure by creating an osmotic gradient between CSF in the arachnoid space and plasma. It is not for long-term use.

Previous
Next:

Diuretics, Loop

Class Summary

Mannitol may reduce subarachnoid-space pressure by creating an osmotic gradient between CSF in the arachnoid space and plasma. It is not for long-term use.

Furosemide (Lasix)

Furosemide lowers ICP by (1) lowering cerebral sodium uptake, (2) affecting water transport into astroglial cells by inhibiting the cellular membrane cation-chloride pump, and (3) decreasing CSF production by inhibiting carbonic anhydrase. It is administered after mannitol.

Previous
Next:

Corticosteroids

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.

Dexamethasone (Baycadron)

Dexamethasone may reduce sensorineural hearing loss in children and infants with H influenzae type B meningitis. Administer this agent to all children with suspected bacterial meningitis (the pathophysiology is likely to be similar). Dexamethasone does not reduce CNS clearance of bacteria or cause treatment failure.

Previous
Next:

Vaccines, Inactivated, Bacterial

Class Summary

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

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

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

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

This is a quadrivalent vaccine for meningitis prophylaxis. It is considered an adjunct to antibiotic chemoprophylaxis.

Meningococcal C and Y/haemophilus influenza type B vaccine (MenHibrix)

Contains antigenic capsular polysaccharides (ie, meningococcal serogroups A and C, Haemophilus influenzae type b) that convey active immunity by stimulating endogenous antibody production; antibodies have been associated with protection from invasive meningococcal disease.

Meningococcal group B vaccine (Bexsero, Trumenba)

Protection against invasive meningococcal disease is conferred mainly by complement-mediated antibody-dependent killing of N meningitidis.

Previous