Meningococcal disease
- Overview
- Theory
- Diagnosis
- Management
- Follow up
- Resources
Treatment algorithm
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer
Look out for this icon: for treatment options that are affected, or added, as a result of your patient's comorbidities.
suspected meningitis
empiric antibiotic therapy
Presumptive treatment for neonatal meningitis should be active against meningococci and other causes of serious bacterial infection, including Listeria.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com Antibiotic therapy should be administered as soon as feasible.
The recommended regimen is ampicillin plus cefotaxime.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com [67]Hasbun R. Progress and challenges in bacterial meningitis: a review. JAMA. 2022 Dec 6;328(21):2147-54. http://www.ncbi.nlm.nih.gov/pubmed/36472590?tool=bestpractice.com
If a cephalosporin cannot be administered (e.g., patients with an allergy), an alternative regimen is ampicillin plus an aminoglycoside (e.g., gentamicin).[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com
Specialist advice should be sought for newborns.
Primary options
ampicillin: consult specialist for guidance on neonatal dose
and
cefotaxime: consult specialist for guidance on neonatal dose
Secondary options
ampicillin: consult specialist for guidance on neonatal dose
and
gentamicin: consult specialist for guidance on neonatal dose
These drug options and doses relate to a patient with no comorbidities.
Primary options
ampicillin: consult specialist for guidance on neonatal dose
and
cefotaxime: consult specialist for guidance on neonatal dose
Secondary options
ampicillin: consult specialist for guidance on neonatal dose
and
gentamicin: consult specialist for guidance on neonatal dose
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
ampicillin
and
cefotaxime
Secondary options
ampicillin
and
gentamicin
supportive care
Treatment recommended for ALL patients in selected patient group
Patients with meningococcal infections must be monitored closely for complications such as shock, elevated intracranial pressure, seizures, and coagulopathy.
Severe meningococcal infections are frequently complicated by hypoglycemia or hyperglycemia, acidosis, and other biochemical abnormalities that require attention.
Patients with symptoms of shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com
Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com
Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com Consult a specialist for guidance on suitable vasopressor/inotrope regimens.
If the patient is hypovolemic or in shock, additional intravenous fluids must be given. Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.
Meningococcal disease is a notifiable disease in many countries, including the US; cases should be reported immediately to local and national health departments.[19]Centers for Disease Control and Prevention. Meningococcal disease. Feb 2024 [internet publication]. https://www.cdc.gov/meningococcal/index.html
empiric antibiotic therapy
Presumptive treatment for bacterial meningitis should be active against meningococci and other causes of serious bacterial infection, including Streptococcus pneumoniae.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com Antibiotic therapy should be administered as soon as feasible.
The recommended regimen is ceftriaxone or cefotaxime plus vancomycin.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com [67]Hasbun R. Progress and challenges in bacterial meningitis: a review. JAMA. 2022 Dec 6;328(21):2147-54. http://www.ncbi.nlm.nih.gov/pubmed/36472590?tool=bestpractice.com
If a cephalosporin cannot be administered (e.g., patients with an allergy), a carbapenem (e.g., meropenem) plus vancomycin can be considered.[81]Mace SE. Acute bacterial meningitis. Emerg Med Clin North Am. 2008 May;26(2):281-317, viii. https://www.doi.org/10.1016/j.emc.2008.02.002 http://www.ncbi.nlm.nih.gov/pubmed/18406976?tool=bestpractice.com
Primary options
vancomycin: children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
or
cefotaxime: children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours
Secondary options
vancomycin: children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
and
meropenem: children ≥3 months of age and <50 kg body weight: 40 mg/kg intravenously every 8 hours, maximum 6 g/day; children ≥3 months of age and ≥50 kg body weight and adults: 2 g intravenously every 8 hours
These drug options and doses relate to a patient with no comorbidities.
Primary options
vancomycin: children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
or
cefotaxime: children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours
Secondary options
vancomycin: children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
and
meropenem: children ≥3 months of age and <50 kg body weight: 40 mg/kg intravenously every 8 hours, maximum 6 g/day; children ≥3 months of age and ≥50 kg body weight and adults: 2 g intravenously every 8 hours
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
vancomycin
-- AND --
ceftriaxone
or
cefotaxime
Secondary options
vancomycin
and
meropenem
supportive care
Treatment recommended for ALL patients in selected patient group
Patients with meningococcal infections must be monitored closely for complications such as shock, elevated intracranial pressure, seizures, and coagulopathy.
Severe meningococcal infections are frequently complicated by hypoglycemia or hyperglycemia, acidosis, and other biochemical abnormalities that require attention.
Patients with shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com
Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[48]McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38. https://www.journalofinfection.com/article/S0163-4453(16)00024-4/fulltext http://www.ncbi.nlm.nih.gov/pubmed/26845731?tool=bestpractice.com [74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com
Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com Consult a specialist for guidance on suitable vasopressor/inotrope regimens.
If the patient is hypovolemic or in shock, additional intravenous fluids must be given. Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.
Meningococcal disease is a notifiable disease in many countries, including the US; cases should be reported immediately to local and national health departments.[19]Centers for Disease Control and Prevention. Meningococcal disease. Feb 2024 [internet publication]. https://www.cdc.gov/meningococcal/index.html
intravenous corticosteroid
Treatment recommended for SOME patients in selected patient group
For suspected bacterial meningitis, most experts recommend that patients older than age 6 weeks receive dexamethasone, with the first dose given prior to or concurrently with the first dose of antibiotics.[48]McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38.
https://www.journalofinfection.com/article/S0163-4453(16)00024-4/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/26845731?tool=bestpractice.com
[68]Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008 Jul;15(7):649-59.
https://www.doi.org/10.1111/j.1468-1331.2008.02193.x
http://www.ncbi.nlm.nih.gov/pubmed/18582342?tool=bestpractice.com
[71]Mount HR, Boyle SD. Aseptic and bacterial meningitis: evaluation, treatment, and prevention. Am Fam Physician. 2017 Sep 1;96(5):314-22.
https://www.aafp.org/pubs/afp/issues/2017/0901/p314.html
http://www.ncbi.nlm.nih.gov/pubmed/28925647?tool=bestpractice.com
[72]Ramirez D, Nigo M, Hasbun R, et al. 1036. Timing and use of adjunctive steroids in adults with bacterial meningitis: compliance with international guidelines. Open Forum Infect Dis. 2022 Dec;9(suppl 2):ofac492.877.
https://academic.oup.com/ofid/article/9/Supplement_2/ofac492.877/6902745
[ 
]
In children with acute bacterial meningitis, is there randomized controlled trial evidence to support adding corticosteroids to standard treatment with antibacterial agents?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1217/fullShow me the answer
[ ]
In adults with acute bacterial meningitis, is adding corticosteroids to standard treatment with antibacterial agents helpful?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1273/fullShow me the answer
Some studies have shown that high-dose corticosteroids reduce the likelihood of neurologic sequelae, particularly in meningitis secondary to Haemophilus influenzae or Streptococcus pneumoniae. The effectiveness of adjuvant corticosteroids in meningitis caused by Neisseria meningitidis is not yet clear.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com [69]Brouwer MC, McIntyre P, Prasad K, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015 Sep 12;(9):CD004405. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004405.pub5/full http://www.ncbi.nlm.nih.gov/pubmed/26362566?tool=bestpractice.com [70]van de Beek D, Farrar JJ, de Gans J, et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol. 2010 Mar;9(3):254-63. http://www.ncbi.nlm.nih.gov/pubmed/20138011?tool=bestpractice.com
Most experts advise discontinuing corticosteroids for bacterial meningitis if the causative organism is proven to be N meningitidis, although some advise that adjunctive treatment should be continued irrespective of the pathogen.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com Corticosteroids should be discontinued if the diagnosis of bacterial meningitis is disproved.
Primary options
dexamethasone sodium phosphate: children >6 weeks of age: 0.15 mg/kg intravenously every 6 hours; adults: 10 mg intravenously every 6 hours
These drug options and doses relate to a patient with no comorbidities.
Primary options
dexamethasone sodium phosphate: children >6 weeks of age: 0.15 mg/kg intravenously every 6 hours; adults: 10 mg intravenously every 6 hours
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
dexamethasone sodium phosphate
empiric antibiotic therapy
Presumptive treatment for bacterial meningitis should be active against meningococci and other causes of serious bacterial infection, including Listeria.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com Antibiotic therapy should be administered as soon as feasible.
The recommended regimen is ampicillin plus ceftriaxone or cefotaxime plus vancomycin.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com [67]Hasbun R. Progress and challenges in bacterial meningitis: a review. JAMA. 2022 Dec 6;328(21):2147-54. http://www.ncbi.nlm.nih.gov/pubmed/36472590?tool=bestpractice.com If ampicillin cannot be administered (e.g., patients with an allergy), trimethoprim/sulfamethoxazole could be considered as an alternative for some patient groups to ensure cover for Listeria monocytogenes in place of ampicillin.[67]Hasbun R. Progress and challenges in bacterial meningitis: a review. JAMA. 2022 Dec 6;328(21):2147-54. http://www.ncbi.nlm.nih.gov/pubmed/36472590?tool=bestpractice.com [81]Mace SE. Acute bacterial meningitis. Emerg Med Clin North Am. 2008 May;26(2):281-317, viii. https://www.doi.org/10.1016/j.emc.2008.02.002 http://www.ncbi.nlm.nih.gov/pubmed/18406976?tool=bestpractice.com Specialist advice should be sought for immunocompromised newborns.
Primary options
ampicillin: neonates: consult specialist for guidance on dose; children: 200-400 mg/kg/day intravenously given in divided doses every 4-6 hours, maximum 12 g/day; adults: 1-2 g intravenously every 3-4 hours
-- AND --
vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
or
cefotaxime: neonates: consult specialist for guidance on dose; children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours
Secondary options
sulfamethoxazole/trimethoprim: children ≥2 months of age and adults: 10-20 mg/kg/day intravenously given in divided doses every 6-12 hours
More sulfamethoxazole/trimethoprimDose refers to trimethoprim component.
-- AND --
vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults:15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
or
cefotaxime: neonates: consult specialist for guidance on dose; children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours
These drug options and doses relate to a patient with no comorbidities.
Primary options
ampicillin: neonates: consult specialist for guidance on dose; children: 200-400 mg/kg/day intravenously given in divided doses every 4-6 hours, maximum 12 g/day; adults: 1-2 g intravenously every 3-4 hours
-- AND --
vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults: 15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
or
cefotaxime: neonates: consult specialist for guidance on dose; children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours
Secondary options
sulfamethoxazole/trimethoprim: children ≥2 months of age and adults: 10-20 mg/kg/day intravenously given in divided doses every 6-12 hours
More sulfamethoxazole/trimethoprimDose refers to trimethoprim component.
-- AND --
vancomycin: neonates: consult specialist for guidance on dose; children: 15 mg/kg intravenously every 6 hours; adults:15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
or
cefotaxime: neonates: consult specialist for guidance on dose; children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
ampicillin
-- AND --
vancomycin
-- AND --
ceftriaxone
or
cefotaxime
Secondary options
sulfamethoxazole/trimethoprim
-- AND --
vancomycin
-- AND --
ceftriaxone
or
cefotaxime
supportive care
Treatment recommended for ALL patients in selected patient group
Patients with meningococcal infections must be monitored closely for complications such as shock, elevated intracranial pressure, seizures, and coagulopathy.
Severe meningococcal infections are frequently complicated by hypoglycemia or hyperglycemia, acidosis, and other biochemical abnormalities that require attention.
Patients with shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com
Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[48]McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38. https://www.journalofinfection.com/article/S0163-4453(16)00024-4/fulltext http://www.ncbi.nlm.nih.gov/pubmed/26845731?tool=bestpractice.com [74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com
Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com Consult a specialist for guidance on suitable vasopressor/inotrope regimens.
If the patient is hypovolemic or in shock, additional intravenous fluids must be given. Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.
Meningococcal disease is a notifiable disease in many countries, including the US; cases should be reported immediately to local and national health departments.[19]Centers for Disease Control and Prevention. Meningococcal disease. Feb 2024 [internet publication]. https://www.cdc.gov/meningococcal/index.html
intravenous corticosteroid
Treatment recommended for SOME patients in selected patient group
For suspected bacterial meningitis, most experts recommend that patients older than age 6 weeks receive dexamethasone, with the first dose given prior to or concurrently with the first dose of antibiotics.[48]McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38.
https://www.journalofinfection.com/article/S0163-4453(16)00024-4/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/26845731?tool=bestpractice.com
[68]Chaudhuri A, Martinez-Martin P, Kennedy PG, et al. EFNS guideline on the management of community-acquired bacterial meningitis: report of an EFNS Task Force on acute bacterial meningitis in older children and adults. Eur J Neurol. 2008 Jul;15(7):649-59.
https://www.doi.org/10.1111/j.1468-1331.2008.02193.x
http://www.ncbi.nlm.nih.gov/pubmed/18582342?tool=bestpractice.com
[71]Mount HR, Boyle SD. Aseptic and bacterial meningitis: evaluation, treatment, and prevention. Am Fam Physician. 2017 Sep 1;96(5):314-22.
https://www.aafp.org/pubs/afp/issues/2017/0901/p314.html
http://www.ncbi.nlm.nih.gov/pubmed/28925647?tool=bestpractice.com
[72]Ramirez D, Nigo M, Hasbun R, et al. 1036. Timing and use of adjunctive steroids in adults with bacterial meningitis: compliance with international guidelines. Open Forum Infect Dis. 2022 Dec;9(suppl 2):ofac492.877.
https://academic.oup.com/ofid/article/9/Supplement_2/ofac492.877/6902745
[ ]
In adults with acute bacterial meningitis, is adding corticosteroids to standard treatment with antibacterial agents helpful?/cca.html?targetUrl=https://cochranelibrary.com/cca/doi/10.1002/cca.1273/fullShow me the answer
Some studies have shown that high-dose corticosteroids reduce the likelihood of neurologic sequelae, particularly in meningitis secondary to Haemophilus influenzae or Streptococcus pneumoniae. The effectiveness of adjuvant corticosteroids in meningitis caused by Neisseria meningitidis is not yet clear.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com [69]Brouwer MC, McIntyre P, Prasad K, et al. Corticosteroids for acute bacterial meningitis. Cochrane Database Syst Rev. 2015 Sep 12;(9):CD004405. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD004405.pub5/full http://www.ncbi.nlm.nih.gov/pubmed/26362566?tool=bestpractice.com [70]van de Beek D, Farrar JJ, de Gans J, et al. Adjunctive dexamethasone in bacterial meningitis: a meta-analysis of individual patient data. Lancet Neurol. 2010 Mar;9(3):254-63. http://www.ncbi.nlm.nih.gov/pubmed/20138011?tool=bestpractice.com
Most experts advise discontinuing corticosteroids for bacterial meningitis if the causative organism is proven to be N meningitidis, although some advise that adjunctive treatment should be continued irrespective of the pathogen.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com Corticosteroids should be discontinued if the diagnosis of bacterial meningitis is disproved.
Primary options
dexamethasone sodium phosphate: children >6 weeks of age: 0.15 mg/kg intravenously every 6 hours; adults: 10 mg intravenously every 6 hours
These drug options and doses relate to a patient with no comorbidities.
Primary options
dexamethasone sodium phosphate: children >6 weeks of age: 0.15 mg/kg intravenously every 6 hours; adults: 10 mg intravenously every 6 hours
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
dexamethasone sodium phosphate
suspected meningococcal bacteremia
empiric antibiotic therapy
Presumptive treatment for suspected bacteremia should be active against meningococci and other causes of serious bacterial infection, including group B Streptococcus agalactiae, Escherichia coli, and Listeria.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com Antibiotic therapy should be administered as soon as feasible.
Cefotaxime or ceftriaxone or ceftazidime or an aminoglycoside (e.g., gentamicin) plus ampicillin is a suitable option in these patients.[73]Gilbert DN, Chambers HF, Saag MS, et al, eds. The Sanford guide to antimicrobial therapy 2022. 52nd ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2022.
The management of suspected bacteremia is becoming increasingly complex and should be based on local susceptibility rates, risk factors (e.g., immunocompromised state, focal infection), and the severity of illness.
Primary options
ampicillin: consult specialist for guidance on neonatal dose
-- AND --
ceftriaxone: consult specialist for guidance on neonatal dose
or
cefotaxime: consult specialist for guidance on neonatal dose
or
ceftazidime sodium: consult specialist for guidance on neonatal dose
or
gentamicin: consult specialist for guidance on neonatal dose
These drug options and doses relate to a patient with no comorbidities.
Primary options
ampicillin: consult specialist for guidance on neonatal dose
-- AND --
ceftriaxone: consult specialist for guidance on neonatal dose
or
cefotaxime: consult specialist for guidance on neonatal dose
or
ceftazidime sodium: consult specialist for guidance on neonatal dose
or
gentamicin: consult specialist for guidance on neonatal dose
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
ampicillin
-- AND --
ceftriaxone
or
cefotaxime
or
ceftazidime sodium
or
gentamicin
acyclovir
Treatment recommended for SOME patients in selected patient group
Acyclovir is indicated in infants with clinical features of herpes simplex virus (HSV) infection, including an ill appearance, mucocutaneous vesicles, seizures, or cerebrospinal fluid pleocytosis.
Primary options
acyclovir: consult specialist for guidance on neonatal dose
These drug options and doses relate to a patient with no comorbidities.
Primary options
acyclovir: consult specialist for guidance on neonatal dose
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
acyclovir
supportive care
Treatment recommended for ALL patients in selected patient group
Patients with meningococcal infections must be monitored closely for complications such as shock, elevated intracranial pressure, seizures, and coagulopathy.
Severe meningococcal infections are frequently complicated by hypoglycemia or hyperglycemia, acidosis, and other biochemical abnormalities that require attention.
Patients with symptoms of shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com
Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com
Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com Consult a specialist for guidance on suitable vasopressor/inotrope regimens.
If the patient is hypovolemic or in shock, additional intravenous fluids must be given. Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.
Meningococcal disease is a notifiable disease in many countries, including the US; cases should be reported immediately to local and national health departments.[19]Centers for Disease Control and Prevention. Meningococcal disease. Feb 2024 [internet publication]. https://www.cdc.gov/meningococcal/index.html
empiric antibiotic therapy
Presumptive treatment for suspected bacteremia should be active against meningococci and other causes of serious bacterial infection, including Streptococcus pneumoniae and Staphylococcus aureus.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com Antibiotic therapy should be administered as soon as feasible.
Ceftriaxone or cefotaxime or ceftriaxone or cefepime plus vancomycin is a suitable option in these patients.[73]Gilbert DN, Chambers HF, Saag MS, et al, eds. The Sanford guide to antimicrobial therapy 2022. 52nd ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2022.
The management of suspected bacteremia is becoming increasingly complex and should be based on local susceptibility rates, risk factors (e.g., immunocompromised state, focal infection), and the severity of illness. Additional antibiotic cover may be required for those with relevant risk factors (e.g., for Listeria).
Primary options
vancomycin: 15 mg/kg intravenously every 6 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day
or
cefotaxime: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day
or
cefepime: children ≥2 months of age: 150 mg/kg/day intravenously given in divided doses every 8 hours
These drug options and doses relate to a patient with no comorbidities.
Primary options
vancomycin: 15 mg/kg intravenously every 6 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day
or
cefotaxime: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day
or
cefepime: children ≥2 months of age: 150 mg/kg/day intravenously given in divided doses every 8 hours
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
vancomycin
-- AND --
ceftriaxone
or
cefotaxime
or
cefepime
supportive care
Treatment recommended for ALL patients in selected patient group
Patients with meningococcal infections must be monitored closely for complications such as shock, elevated intracranial pressure, seizures, and coagulopathy.
Severe meningococcal infections are frequently complicated by hypoglycemia or hyperglycemia, acidosis, and other biochemical abnormalities that require attention.
Patients with symptoms of shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com
Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com
Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com Consult a specialist for guidance on suitable vasopressor/inotrope regimens.
If the patient is hypovolemic or in shock, additional intravenous fluids must be given. Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.
Meningococcal disease is a notifiable disease in many countries, including the US; cases should be reported immediately to local and national health departments.[19]Centers for Disease Control and Prevention. Meningococcal disease. Feb 2024 [internet publication]. https://www.cdc.gov/meningococcal/index.html
empiric antibiotic therapy
Presumptive treatment for suspected bacteremia should be active against meningococci and other causes of serious bacterial infection, including Streptococcus pneumoniae and Staphylococcus aureus.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com Antibiotic therapy should be administered as soon as feasible. Therapy should include one or more broad-spectrum antibiotics active against gram-positive and gram-negative organisms.
Vancomycin plus ceftriaxone or cefotaxime or cefepime or imipenem/cilastatin or meropenem with or without an aminoglycoside (e.g., gentamicin) is a suitable option in these patients.[73]Gilbert DN, Chambers HF, Saag MS, et al, eds. The Sanford guide to antimicrobial therapy 2022. 52nd ed. Sperryville, VA: Antimicrobial Therapy, Inc; 2022.
The management of suspected bacteremia is becoming increasingly complex and should be based on local microbiology, personal risk factors (e.g., immunocompromised state, focal infection), age, and the severity of illness. Additional antibiotic cover may be required for those with relevant risk factors (e.g., for Listeria).
Primary options
vancomycin: 15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: 2 g intravenously every 12 hours
or
cefotaxime: 2 g intravenously every 4-6 hours
or
cefepime: 2 g intravenously every 8 hours
or
imipenem/cilastatin: 500 mg intravenously every 6 hours
More imipenem/cilastatinDose refers to imipenem component.
or
meropenem: 2 g intravenously every 8 hours
OR
vancomycin: 15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: 2 g intravenously every 12 hours
or
cefotaxime: 2 g intravenously every 4 hours
or
cefepime: 2 g intravenously every 8 hours
or
imipenem/cilastatin: 500 mg intravenously every 6 hours
More imipenem/cilastatinDose refers to imipenem component.
or
meropenem: 2 g intravenously every 8 hours
-- AND --
gentamicin: 5 mg/kg/day intravenously given in 1-3 divided doses
More gentamicinAdjust dose according to serum gentamicin level.
These drug options and doses relate to a patient with no comorbidities.
Primary options
vancomycin: 15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: 2 g intravenously every 12 hours
or
cefotaxime: 2 g intravenously every 4-6 hours
or
cefepime: 2 g intravenously every 8 hours
or
imipenem/cilastatin: 500 mg intravenously every 6 hours
More imipenem/cilastatinDose refers to imipenem component.
or
meropenem: 2 g intravenously every 8 hours
OR
vancomycin: 15-20 mg/kg intravenously every 8-12 hours
More vancomycinAdjust dose according to serum vancomycin level.
-- AND --
ceftriaxone: 2 g intravenously every 12 hours
or
cefotaxime: 2 g intravenously every 4 hours
or
cefepime: 2 g intravenously every 8 hours
or
imipenem/cilastatin: 500 mg intravenously every 6 hours
More imipenem/cilastatinDose refers to imipenem component.
or
meropenem: 2 g intravenously every 8 hours
-- AND --
gentamicin: 5 mg/kg/day intravenously given in 1-3 divided doses
More gentamicinAdjust dose according to serum gentamicin level.
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
vancomycin
-- AND --
ceftriaxone
or
cefotaxime
or
cefepime
or
imipenem/cilastatin
or
meropenem
OR
vancomycin
-- AND --
ceftriaxone
or
cefotaxime
or
cefepime
or
imipenem/cilastatin
or
meropenem
-- AND --
gentamicin
supportive care
Treatment recommended for ALL patients in selected patient group
Patients with meningococcal infections must be monitored closely for complications such as shock, elevated intracranial pressure, seizures, and coagulopathy.
Severe meningococcal infections are frequently complicated by hypoglycemia or hyperglycemia, acidosis, and other biochemical abnormalities that require attention.
Patients with shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com
Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[48]McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38. https://www.journalofinfection.com/article/S0163-4453(16)00024-4/fulltext http://www.ncbi.nlm.nih.gov/pubmed/26845731?tool=bestpractice.com [74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com
Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com Consult a specialist for guidance on suitable vasopressor/inotrope regimens.
If the patient is hypovolemic or in shock, additional intravenous fluids must be given. Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.
Meningococcal disease is a notifiable disease in many countries, including the US; cases should be reported immediately to local and national health departments.[19]Centers for Disease Control and Prevention. Meningococcal disease. Feb 2024 [internet publication]. https://www.cdc.gov/meningococcal/index.html
confirmed meningococcal meningitis: penicillin-susceptible
targeted antibiotic therapy
After diagnosis is confirmed (generally within 12-48 hours of admission to the hospital), antimicrobial therapy can be modified according to the causative organism and antibiotic susceptibilities.[67]Hasbun R. Progress and challenges in bacterial meningitis: a review. JAMA. 2022 Dec 6;328(21):2147-54. http://www.ncbi.nlm.nih.gov/pubmed/36472590?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com Typically, the duration of antibacterial treatment depends on the clinical response and the cerebrospinal fluid microbiologic response after treatment has started. Most experts advise discontinuing corticosteroids for bacterial meningitis if the causative organism is proven to be Neisseria meningitidis, although some advise that adjunctive treatment should be continued irrespective of the pathogen.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com
Neisseria meningitidis that is penicillin-susceptible (minimum inhibitory concentration [MIC] <0.1 micrograms/mL) should be treated with ampicillin or penicillin-G. Alternatives include a third-generation cephalosporin (e.g., ceftriaxone).[67]Hasbun R. Progress and challenges in bacterial meningitis: a review. JAMA. 2022 Dec 6;328(21):2147-54. http://www.ncbi.nlm.nih.gov/pubmed/36472590?tool=bestpractice.com [77]Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004 Nov 1;39(9):1267-84. https://www.doi.org/10.1086/425368 http://www.ncbi.nlm.nih.gov/pubmed/15494903?tool=bestpractice.com
Treatment course: 7 days.
Primary options
penicillin G potassium: neonates: consult specialist for guidance on dose; children: 250,000 to 400,000 units/kg/day intravenously given in divided doses every 4-6 hours, maximum 24 million units/day; adults: 2 million units intravenously every 2 hours
OR
ampicillin: neonates: consult specialist for guidance on dose; children: 200-400 mg/kg/day intravenously given in divided doses every 4-6 hours, maximum 12 g/day; adults: 1-2 g intravenously every 3-4 hours
Secondary options
ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
These drug options and doses relate to a patient with no comorbidities.
Primary options
penicillin G potassium: neonates: consult specialist for guidance on dose; children: 250,000 to 400,000 units/kg/day intravenously given in divided doses every 4-6 hours, maximum 24 million units/day; adults: 2 million units intravenously every 2 hours
OR
ampicillin: neonates: consult specialist for guidance on dose; children: 200-400 mg/kg/day intravenously given in divided doses every 4-6 hours, maximum 12 g/day; adults: 1-2 g intravenously every 3-4 hours
Secondary options
ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
penicillin G potassium
OR
ampicillin
Secondary options
ceftriaxone
supportive care
Treatment recommended for ALL patients in selected patient group
Patients with meningococcal infections must be monitored closely for complications such as shock, elevated intracranial pressure, seizures, and coagulopathy.
Severe meningococcal infections are frequently complicated by hypoglycemia or hyperglycemia, acidosis, and other biochemical abnormalities that require attention.
Patients with shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com
Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[48]McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38. https://www.journalofinfection.com/article/S0163-4453(16)00024-4/fulltext http://www.ncbi.nlm.nih.gov/pubmed/26845731?tool=bestpractice.com [74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com
Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com Consult a specialist for guidance on suitable vasopressor/inotrope regimens.
If the patient is hypovolemic or in shock, additional intravenous fluids must be given. Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.
nasopharyngeal eradication predischarge
Treatment recommended for ALL patients in selected patient group
Patients with invasive meningococcal infections who are not treated with ceftriaxone or cefotaxime should also receive rifampin, ciprofloxacin, or ceftriaxone before discharge from the hospital, to eradicate nasopharyngeal colonization.[4]Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases: the pink book. 14th ed. Chapter 14: meningococcal disease. Apr 2024 [internet publication]. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-14-meningococcal-disease.html [50]American Academy of Pediatrics. Meningococcal infections. In: Kimberlin DW, Banerjee R, Barnett ED, et al, eds. Red Book: 2024-2027 report of the Committee on Infectious Diseases. 33rd ed. Itasca, IL: American Academy of Pediatrics; 2024:585-99. https://doi.org/10.1542/9781610027373-S3_012_003
These treatments are equally effective. Choice is based on the age of the patient and the presence of any contraindications to an individual drug. Specialist advice should be sought for newborns.
Primary options
rifampin: children: 20 mg/kg/day orally given in 2 divided doses for 2 days, maximum 600 mg/dose; adults: 600 mg orally twice daily for 2 days
OR
ceftriaxone: children: 125 mg intramuscularly as a single dose; adults: 250 mg intramuscularly as a single dose
OR
ciprofloxacin: adults: 500 mg orally as a single dose
These drug options and doses relate to a patient with no comorbidities.
Primary options
rifampin: children: 20 mg/kg/day orally given in 2 divided doses for 2 days, maximum 600 mg/dose; adults: 600 mg orally twice daily for 2 days
OR
ceftriaxone: children: 125 mg intramuscularly as a single dose; adults: 250 mg intramuscularly as a single dose
OR
ciprofloxacin: adults: 500 mg orally as a single dose
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
rifampin
OR
ceftriaxone
OR
ciprofloxacin
confirmed meningococcal meningitis: penicillin-intermediate sensitivity
targeted antibiotic therapy
After diagnosis is confirmed (generally within 12-48 hours of admission to the hospital), antimicrobial therapy can be modified according to the causative organism and antibiotic susceptibilities.[67]Hasbun R. Progress and challenges in bacterial meningitis: a review. JAMA. 2022 Dec 6;328(21):2147-54. http://www.ncbi.nlm.nih.gov/pubmed/36472590?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com Typically, the duration of antibacterial treatment depends on the clinical response and the cerebrospinal fluid microbiologic response after treatment has started. Most experts advise discontinuing corticosteroids for bacterial meningitis if the causative organism is proven to be Neisseria meningitidis, although some advise that adjunctive treatment should be continued irrespective of the pathogen.[54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com
Neisseria meningitidis that is penicillin-intermediate susceptible (minimum inhibitory concentration [MIC] 0.1 to 1.0 micrograms/mL) should be treated with ceftriaxone or cefotaxime. Alternatives include a fluoroquinolone (e.g., levofloxacin, ciprofloxacin) or meropenem.[67]Hasbun R. Progress and challenges in bacterial meningitis: a review. JAMA. 2022 Dec 6;328(21):2147-54. http://www.ncbi.nlm.nih.gov/pubmed/36472590?tool=bestpractice.com [77]Tunkel AR, Hartman BJ, Kaplan SL, et al. Practice guidelines for the management of bacterial meningitis. Clin Infect Dis. 2004 Nov 1;39(9):1267-84. https://www.doi.org/10.1086/425368 http://www.ncbi.nlm.nih.gov/pubmed/15494903?tool=bestpractice.com
Systemic fluoroquinolone antibiotics may cause serious, disabling, and potentially long-lasting or irreversible adverse events. This includes, but is not limited to: tendinopathy/tendon rupture; peripheral neuropathy; arthropathy/arthralgia; aortic aneurysm and dissection; heart valve regurgitation; dysglycemia; and central nervous system effects including seizures, depression, psychosis, and suicidal thoughts and behavior.[78]Rusu A, Munteanu AC, Arbănași EM, et al. Overview of side-effects of antibacterial fluoroquinolones: new drugs versus old drugs, a step forward in the safety profile? Pharmaceutics. 2023 Mar 1;15(3):804. https://www.doi.org/10.3390/pharmaceutics15030804 http://www.ncbi.nlm.nih.gov/pubmed/36986665?tool=bestpractice.com Prescribing restrictions apply to the use of fluoroquinolones, and these restrictions may vary between countries. In general, fluoroquinolones should be restricted for use in serious, life-threatening bacterial infections only. Some regulatory agencies may also recommend that they must only be used in situations where other antibiotics that are commonly recommended for the infection are inappropriate (e.g., resistance, contraindications, treatment failure, unavailability). Consult your local guidelines and drug information source for more information on suitability, contraindications, and precautions.
Treatment course: 7 days.
Primary options
ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
OR
cefotaxime: neonates: consult specialist for guidance on dose; children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours
Secondary options
meropenem: children ≥3 months of age and <50 kg body weight: 40 mg/kg intravenously every 8 hours, maximum 6 g/day; children ≥3 months of age and ≥50 kg body weight and adults: 2 g intravenously every 8 hours
OR
levofloxacin: children: consult specialist for guidance on dose; adults: 750 mg intravenously every 24 hours
OR
ciprofloxacin: children: consult specialist for guidance on dose; adults: 400 mg intravenously every 8-12 hours
These drug options and doses relate to a patient with no comorbidities.
Primary options
ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
OR
cefotaxime: neonates: consult specialist for guidance on dose; children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours
Secondary options
meropenem: children ≥3 months of age and <50 kg body weight: 40 mg/kg intravenously every 8 hours, maximum 6 g/day; children ≥3 months of age and ≥50 kg body weight and adults: 2 g intravenously every 8 hours
OR
levofloxacin: children: consult specialist for guidance on dose; adults: 750 mg intravenously every 24 hours
OR
ciprofloxacin: children: consult specialist for guidance on dose; adults: 400 mg intravenously every 8-12 hours
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
ceftriaxone
OR
cefotaxime
Secondary options
meropenem
OR
levofloxacin
OR
ciprofloxacin
supportive care
Treatment recommended for ALL patients in selected patient group
Patients with meningococcal infections must be monitored closely for complications such as shock, elevated intracranial pressure, seizures, and coagulopathy.
Severe meningococcal infections are frequently complicated by hypoglycemia or hyperglycemia, acidosis, and other biochemical abnormalities that require attention.
Patients with shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com
Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[48]McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38. https://www.journalofinfection.com/article/S0163-4453(16)00024-4/fulltext http://www.ncbi.nlm.nih.gov/pubmed/26845731?tool=bestpractice.com [74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com
Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com Consult a specialist for guidance on suitable vasopressor/inotrope regimens.
If the patient is hypovolemic or in shock, additional intravenous fluids must be given. Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.
nasopharyngeal eradication predischarge
Treatment recommended for ALL patients in selected patient group
Patients with invasive meningococcal infections who are not treated with ceftriaxone or cefotaxime should also receive rifampin, ciprofloxacin, or ceftriaxone before discharge from the hospital, to eradicate nasopharyngeal colonization.[4]Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases: the pink book. 14th ed. Chapter 14: meningococcal disease. Apr 2024 [internet publication]. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-14-meningococcal-disease.html [50]American Academy of Pediatrics. Meningococcal infections. In: Kimberlin DW, Banerjee R, Barnett ED, et al, eds. Red Book: 2024-2027 report of the Committee on Infectious Diseases. 33rd ed. Itasca, IL: American Academy of Pediatrics; 2024:585-99. https://doi.org/10.1542/9781610027373-S3_012_003
These treatments are equally effective. Choice is based on the age of the patient and the presence of any contraindications to an individual drug. Specialist advice should be sought for newborns.
Primary options
rifampin: children: 20 mg/kg/day orally given in 2 divided doses for 2 days, maximum 600 mg/dose; adults: 600 mg orally twice daily for 2 days
OR
ceftriaxone: children: 125 mg intramuscularly as a single dose; adults: 250 mg intramuscularly as a single dose
OR
ciprofloxacin: adults: 500 mg orally as a single dose
These drug options and doses relate to a patient with no comorbidities.
Primary options
rifampin: children: 20 mg/kg/day orally given in 2 divided doses for 2 days, maximum 600 mg/dose; adults: 600 mg orally twice daily for 2 days
OR
ceftriaxone: children: 125 mg intramuscularly as a single dose; adults: 250 mg intramuscularly as a single dose
OR
ciprofloxacin: adults: 500 mg orally as a single dose
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
rifampin
OR
ceftriaxone
OR
ciprofloxacin
confirmed meningococcal bacteremia
targeted antibiotic therapy
Once the diagnosis of a meningococcal infection is confirmed, the patient should be treated with an intravenous cephalosporin (e.g., ceftriaxone or cefotaxime). Treatment is usually for a duration of 5-7 days depending on the patient's age, severity of infection, and response to initial therapy.[50]American Academy of Pediatrics. Meningococcal infections. In: Kimberlin DW, Banerjee R, Barnett ED, et al, eds. Red Book: 2024-2027 report of the Committee on Infectious Diseases. 33rd ed. Itasca, IL: American Academy of Pediatrics; 2024:585-99. https://doi.org/10.1542/9781610027373-S3_012_003
If the patient is receiving dexamethasone for suspected meningitis, this should be discontinued.[47]National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. Mar 2024 [internet publication]. https://www.nice.org.uk/guidance/ng240 [54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com
Primary options
ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
OR
cefotaxime: neonates: consult specialist for guidance on dose; children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours
These drug options and doses relate to a patient with no comorbidities.
Primary options
ceftriaxone: neonates: consult specialist for guidance on dose; children: 80-100 mg/kg/day intravenously given in divided doses every 12-24 hours, maximum 4 g/day; adults: 2 g intravenously every 12 hours
OR
cefotaxime: neonates: consult specialist for guidance on dose; children: 200-300 mg/kg/day intravenously given in divided doses every 6-8 hours, maximum 12 g/day; adults: 2 g intravenously every 4-6 hours
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
ceftriaxone
OR
cefotaxime
supportive care
Treatment recommended for ALL patients in selected patient group
Patients with meningococcal infections must be monitored closely for complications such as shock, elevated intracranial pressure, seizures, and coagulopathy.
Severe meningococcal infections are frequently complicated by hypoglycemia or hyperglycemia, acidosis, and other biochemical abnormalities that require attention.
Patients with shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com
Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[48]McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38. https://www.journalofinfection.com/article/S0163-4453(16)00024-4/fulltext http://www.ncbi.nlm.nih.gov/pubmed/26845731?tool=bestpractice.com [74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com
Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com Consult a specialist for guidance on suitable vasopressor/inotrope regimens.
If the patient is hypovolemic or in shock, additional intravenous fluids must be given. Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.
alternative targeted antibiotic therapy
Where a cephalosporin is not appropriate, alternative agents include penicillin-G, ampicillin, meropenem, or chloramphenicol. Choice of agent is based on individual patient age, circumstances, and antibiotic susceptibilities, and on local availability.
Treatment of infections caused by resistant strains should be based on results of antibiotic susceptibility testing.
If the patient is receiving dexamethasone for suspected meningitis, this should be discontinued.[47]National Institute for Health and Care Excellence. Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management. Mar 2024 [internet publication]. https://www.nice.org.uk/guidance/ng240 [54]van de Beek D, Cabellos C, Dzupova O, et al. ESCMID guideline: diagnosis and treatment of acute bacterial meningitis. Clin Microbiol Infect. 2016 May;22 Suppl 3:S37-62. https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(16)00020-3/fulltext http://www.ncbi.nlm.nih.gov/pubmed/27062097?tool=bestpractice.com
Specialist advice should be sought for newborns.
Primary options
penicillin G potassium: neonates: consult specialist for guidance on dose; children: 250,000 to 400,000 units/kg/day intravenously given in divided doses every 4-6 hours, maximum 24 million units/day; adults: 2 million units intravenously every 2 hours
OR
ampicillin: neonates: consult specialist for guidance on dose; children: 200-400 mg/kg/day intravenously given in divided doses every 4-6 hours, maximum 12 g/day; adults: 1-2 g intravenously every 3-4 hours
OR
meropenem: children ≥3 months of age and <50 kg body weight: 40 mg/kg intravenously every 8 hours, maximum 6 g/day; children ≥3 months of age and ≥50 kg body weight and adults: 2 g intravenously every 8 hours
OR
chloramphenicol: children ≥1 month of age and adults: 75-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4 g/day
These drug options and doses relate to a patient with no comorbidities.
Primary options
penicillin G potassium: neonates: consult specialist for guidance on dose; children: 250,000 to 400,000 units/kg/day intravenously given in divided doses every 4-6 hours, maximum 24 million units/day; adults: 2 million units intravenously every 2 hours
OR
ampicillin: neonates: consult specialist for guidance on dose; children: 200-400 mg/kg/day intravenously given in divided doses every 4-6 hours, maximum 12 g/day; adults: 1-2 g intravenously every 3-4 hours
OR
meropenem: children ≥3 months of age and <50 kg body weight: 40 mg/kg intravenously every 8 hours, maximum 6 g/day; children ≥3 months of age and ≥50 kg body weight and adults: 2 g intravenously every 8 hours
OR
chloramphenicol: children ≥1 month of age and adults: 75-100 mg/kg/day intravenously given in divided doses every 6 hours, maximum 4 g/day
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
penicillin G potassium
OR
ampicillin
OR
meropenem
OR
chloramphenicol
supportive care
Treatment recommended for ALL patients in selected patient group
Patients with meningococcal infections must be monitored closely for complications such as shock, elevated intracranial pressure, seizures, and coagulopathy.
Severe meningococcal infections are frequently complicated by hypoglycemia or hyperglycemia, acidosis, and other biochemical abnormalities that require attention.
Patients with shock (pulse rate may be persistently elevated, the skin mottled, the extremities cool due to increased systemic vascular resistance, the capillary refilling prolonged, and the urinary output decreased) or respiratory distress should receive appropriate respiratory support. This might include supplemental oxygen, or intubation and mechanical ventilation for those with severe respiratory distress, altered consciousness, or evidence of elevated intracranial pressure.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com
Adequate oxygenation, prevention of hypoglycemia and hyponatremia, anticonvulsant therapy if needed for early control of seizures, and measures to decrease intracranial pressure and to prevent fluctuating cerebral blood flow are important in management.[48]McGill F, Heyderman RS, Michael BD, et al. The UK joint specialist societies guideline on the diagnosis and management of acute meningitis and meningococcal sepsis in immunocompetent adults. J Infect. 2016 Apr;72(4):405-38. https://www.journalofinfection.com/article/S0163-4453(16)00024-4/fulltext http://www.ncbi.nlm.nih.gov/pubmed/26845731?tool=bestpractice.com [74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com [76]Sáez-Llorens X, McCracken GH Jr. Bacterial meningitis in children. Lancet. 2003 Jun 21;361(9375):2139-48. http://www.ncbi.nlm.nih.gov/pubmed/12826449?tool=bestpractice.com
Vasopressors should be given to patients with hypotension or poor perfusion who do not respond promptly to fluid resuscitation.[74]Evans L, Rhodes A, Alhazzani W, et al. Surviving Sepsis Campaign: international guidelines for management of sepsis and septic shock 2021. Crit Care Med. 2021 Nov 1;49(11):e1063-143. https://journals.lww.com/ccmjournal/Fulltext/2021/11000/Surviving_Sepsis_Campaign__International.21.aspx http://www.ncbi.nlm.nih.gov/pubmed/34605781?tool=bestpractice.com [75]Weiss SL, Peters MJ, Alhazzani W, et al. Surviving sepsis campaign international guidelines for the management of septic shock and sepsis-associated organ dysfunction in children. Intensive Care Med. 2020 Feb;46(suppl 1):10-67. https://www.doi.org/10.1007/s00134-019-05878-6 http://www.ncbi.nlm.nih.gov/pubmed/32030529?tool=bestpractice.com Consult a specialist for guidance on suitable vasopressor/inotrope regimens.
If the patient is hypovolemic or in shock, additional intravenous fluids must be given. Fluids should be given cautiously to patients with evidence of elevated intracranial pressure, myocardial dysfunction, or acute respiratory distress syndrome.
nasopharyngeal eradication predischarge
Treatment recommended for ALL patients in selected patient group
Patients with invasive meningococcal infections who are not treated with ceftriaxone or cefotaxime should also receive rifampin, ciprofloxacin, or ceftriaxone before discharge from the hospital, to eradicate nasopharyngeal colonization.[4]Centers for Disease Control and Prevention. Epidemiology and prevention of vaccine-preventable diseases: the pink book. 14th ed. Chapter 14: meningococcal disease. Apr 2024 [internet publication]. https://www.cdc.gov/pinkbook/hcp/table-of-contents/chapter-14-meningococcal-disease.html [50]American Academy of Pediatrics. Meningococcal infections. In: Kimberlin DW, Banerjee R, Barnett ED, et al, eds. Red Book: 2024-2027 report of the Committee on Infectious Diseases. 33rd ed. Itasca, IL: American Academy of Pediatrics; 2024:585-99. https://doi.org/10.1542/9781610027373-S3_012_003
These treatments are equally effective. Choice is based on the age of the patient and the presence of any contraindications to an individual drug. Specialist advice should be sought for newborns.
Primary options
rifampin: children: 20 mg/kg/day orally given in 2 divided for 2 days, maximum 600 mg/dose; adults: 600 mg orally twice daily for 2 days
OR
ceftriaxone: children: 125 mg intramuscularly as a single dose; adults: 250 mg intramuscularly as a single dose
OR
ciprofloxacin: adults: 500 mg orally as a single dose
These drug options and doses relate to a patient with no comorbidities.
Primary options
rifampin: children: 20 mg/kg/day orally given in 2 divided for 2 days, maximum 600 mg/dose; adults: 600 mg orally twice daily for 2 days
OR
ceftriaxone: children: 125 mg intramuscularly as a single dose; adults: 250 mg intramuscularly as a single dose
OR
ciprofloxacin: adults: 500 mg orally as a single dose
Drug choice, dose and interactions may be affected by the patient's comorbidities. Check your local drug formulary.
Show drug information for a patient with no comorbidities
Primary options
rifampin
OR
ceftriaxone
OR
ciprofloxacin
Choose a patient group to see our recommendations
Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups. See disclaimer
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