5.
Therapies
N. meningitidis bacterial infection is a medical emergency, requiring immediate admission to hospital. Diagnosis relies intensely on pathological tests, including blood cultures and serology, and cerebrospinal fluid (CSF) testing.
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On admission to a secondary care setting (hospital), patients should first be assessed to ensure their airway, breathing, and circulation (ABC) is stable. If the individual is experiencing difficulties, then the primary focus is to manage this. The Royal College of Physicians recommends acute medical patients are to be reviewed by a consultant no more than 14 hours post admission [64].
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In patients with meningococcal disease, circulating plasma endotoxins are decreased by use of antibiotic treatment. Rapid administration of antibiotic therapies reduces complications, such as septic shock and intracranial pressure, and decreases the risk of mortality for the patient.
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Corticosteroids, such as dexamethasone, decreases the inflammatory response in the CSF and has shown to reverse oedema in the brain. This therefore reduces discomfort for the patient, along with an improved outcome [65].
If meningitis is suspected by a clinician, ceftriaxone as empirical treatment should be started [66]. Dosing for ceftriaxone is shown in table 3.
Once a diagnosis is definite, treatment with penicillin (benzylpenicillin sodium or, ampicillin) is the preferred choice. However, individuals with a penicillin allergy should be treated with cephalosporins (cefotaxime or, ceftriaxone) [67]. Refer to table 1 for penicillin dosing.
Cefotaxime should be given quickly when meningitis is suspected prior to admission to hospital, for example given by paramedics. Ciprofloxacin prophylaxis should be administered to immediate contacts of individuals with meningococcal disease, or rifampicin as an alternative [68].
Cefotaxime can be given either intravenously (IV) or intramuscularly (IM) and given as a dose of 1g for patients aged 12 upwards. Children under this age are given a dose of 50 mg/kg, see table 2 for dosing.
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Additional to antibiotic therapy, 10 mg of dexamethasone IV every 6-hourly. This is prescribed as 0.15mg/kg of dexamethasone 4 times a day, recommended for 2-4 days [67].
Before antibiotics were used as a treatment for N. meningitidis, 70-85% of cases were fatal, however with treatment today the mortality rate is 10-15% [72].
References
64. Griffiths, M., McGill, F. and Solomon, T., 2018. Management of acute meningitis. Clinical Medicine, 18(2), pp.164-169.
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65. Brouwer, M., McIntyre, P., Prasad, K. and van de Beek, D., 2015. Corticosteroids for acute bacterial meningitis. Cochrane Database of Systematic Reviews, (9).
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66. Murray, P., Rosenthal, K. and Pfaller, M., 2015. Medical microbiology. 8th ed. Elsevier, p.235.
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67. Brooks, G., Carroll, K., Butel, J. and Morse, S., 2007. Jawetz, Melnick & Adelberg's Medical Microbiology. 24th ed. McGraw-Hill Medical, pp.176, 302, 303.
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68. Willerton, L., Lucidarme, J., Walker, A., Lekshmi, A., Clark, S., Walsh, L., Bai, X., Lee-Jones, L. and Borrow, R., 2021. Antibiotic resistance among invasive Neisseria meningitidis isolates in England, Wales and Northern Ireland (2010/11 to 2018/19). PLOS ONE, 16(11), pp.1-19.
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69. NICE Excellence., 2021. BENZYLPENICILLIN SODIUM | Drug | BNF content published by NICE. [online] Bnf.nice.org.uk. Available at: <https://bnf.nice.org.uk/drug/benzylpenicillin-sodium.html> [Accessed 5 November 2021].
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70. NICE Excellence., 2021. CEFOTAXIME | Drug | BNF content published by NICE. [online] Bnf.nice.org.uk. Available at: <https://bnf.nice.org.uk/drug/cefotaxime.html> [Accessed 5 November 2021].
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71. NICE Excellence., 2021. CEFTRIAXONE | Drug | BNF content published by NICE. [online] Bnf.nice.org.uk. Available at: <https://bnf.nice.org.uk/drug/ceftriaxone.html#indicationsAndDoses> [Accessed 5 November 2021].
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72. Rouphael, N. and Stephens, D., 2012. Neisseria meningitidis: Biology, Microbiology, and Epidemiology. Methods in Molecular Biology, 799, pp.1-20.