Neisseria meningitidis (meningococcal) meningitis

In adults and children with meningitis caused by Neisseria meningitidis (meningococcal meningitis), drug choice depends on whether susceptibility to benzylpenicillin has been confirmed and whether the patient is hypersensitive to penicillins. When N. meningitidis infection is confirmed:

start directed therapy (see regimens below)
stop dexamethasone therapy because it is of no benefit
start clearance antibiotics for N. meningitidis in close contacts
report the case of invasive meningococcal meningitis to the local public health authority because it is a notifiable condition¹ ².

For the treatment of meningitis caused by N. meningitidis in adults and children, use:

1ceftriaxone 2 g (child 1 month or older: 50 mg/kg up to 2 g) intravenously, 12-hourly for 5 days³ ceftriaxone ceftriaxone ceftriaxone

1cefotaxime 2 g (child: 50 mg/kg up to 2 g) intravenously, 6-hourly for 5 days. For dosage adjustment in adults with kidney impairment, see cefotaxime dosage adjustment. cefotaxime cefotaxime cefotaxime

If susceptibility to benzylpenicillin is confirmed, de-escalate therapy and use:

benzylpenicillin 2.4 g (child: 60 mg/kg up to 2.4 g) intravenously, 4-hourly for 5 days. For dosage adjustment in adults with kidney impairment, see benzylpenicillin dosage adjustment. benzylpenicillin benzylpenicillin benzylpenicillin

Clearance antibiotics for N. meningitidis are required if the patient was treated with benzylpenicillin alone, because it does not reliably clear nasopharyngeal carriage.

For patients who have had a nonsevere (immediate or delayed) or severe immediate⁴ hypersensitivity reaction to a penicillin, use ceftriaxone or cefotaxime (see dosages above).

For patients who have had a severe delayed⁵ hypersensitivity reaction to a penicillin, use:

ciprofloxacin 400 mg (child: 10 mg/kg up to 400 mg) intravenously, 8-hourly for 5 days⁶. For dosage adjustment in adults with kidney impairment, see ciprofloxacin intravenous dosage adjustment. ciprofloxacin ciprofloxacin ciprofloxacin

¹ For Australian national notifiable diseases and case definitions, see the Communicable Diseases Network Australia (CDNA) website.Return

² Contact details for Australian state and territory government health departments and public health units are available here.Return

³ In children, a single daily dose of ceftriaxone (100 mg/kg up to 4 g intravenously, daily) is used in some centres. A single daily dose of ceftriaxone may also be used when patients complete their course of treatment at home in an ambulatory antimicrobial therapy program.Return

⁴ Severe immediate hypersensitivity reactions include anaphylaxis, compromised airway, airway angioedema, hypotension and collapse.Return

⁵ Severe delayed hypersensitivity reactions include cutaneous adverse drug reactions (eg drug rash with eosinophilia and systemic symptoms [DRESS], Stevens–Johnson syndrome/toxic epidermal necrolysis [SJS/TEN], severe blistering or desquamative rash), and significant internal organ involvement (eg acute interstitial nephritis).Return

⁶ Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Ciprofloxacin can be used in children when it is the drug of choice.Return