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How is meningococcal infection treated?
Last reviewed: 04.07.2025
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Drug treatment of meningococcal infection
Treatment of meningococcal infection depends on the clinical form of the disease. In case of nasopharyngitis, therapy is symptomatic. If the diagnosis is confirmed bacteriologically, benzylpenicillin, ampicillin, cephalosporins of the first and second generations, chloramphenicol, pefloxacin are used in average therapeutic doses for 3 days. Co-trimoxazole and aminoglycosides should not be used, to which most currently existing strains of meningococcus are resistant.
Patients or individuals with a presumptive diagnosis of a generalized form of meningococcal infection are subject to emergency hospitalization in specialized departments of infectious disease hospitals.
The drug of choice for the treatment of generalized forms of meningococcal infection remains benzylpenicillin, to which almost all strains of meningococcus are sensitive. Penicillin is prescribed in a daily dose of 200-300 thousand U/kg, single doses are administered at intervals of 4 hours. With intravenous administration, the daily dose is increased to 300-400 thousand U/kg. In case of late admission, meningoencephalitis, it is advisable to increase the dose to 400-500 thousand U/kg.
Ceftriaxone is highly effective, possessing pronounced antimicrobial activity and satisfactory passage through the BBB. Adults are prescribed a single dose of 4 g, children - 100 mg/kg, but not more than 4 g/day. Iefotaxime is also effective at a dose of 200 mg/kg (not more than 12 g/day).
Chloramphenicol is also used at a dose of 80-100 mg/kg per day in 2-3 doses, fluoroquinolones of the third generation. Antibiotics penetrate into the subarachnoid space only in the presence of an inflammatory process, therefore, during the treatment period, situations are possible when the concentration of these drugs can decrease below the therapeutic one and the bactericidal effect cannot be achieved. In this regard, penicillin has an advantage due to its very low toxicity, the absence of nephrotoxic and hepatotoxic effects, the dose can be increased to 500 thousand U/kg or more.
Antimicrobial treatment of meningococcal infection depends on the time of cerebrospinal fluid sanation and is from 5 to 10 days. It has been established that with a decrease in cytosis below 100 in 1 μl (and in children under one year - below 50 in 1 μl) and the number of neutrophils less than 30% in meningococcal meningitis, the cerebrospinal fluid is sterile.
Detoxification therapy of uncomplicated generalized formsdiseases are treated according to general rules. Pathogenetic treatment of meningococcal infection is based on the use of analgesics and sedatives.
In meningococcal meningitis, the main direction of pathogenetic therapy is dehydration, the purpose of which is to reduce cerebral edema and intracranial hypertension by mobilizing fluid from the subarachnoid space and brain matter. Furosemide is most effective in a daily dose of 20-40 mg, maximum - 80 mg, for children - up to 6 mg / kg. Intensive dehydration in normovolemia mode is carried out in the first 5-7 days, then weaker diuretics are used, in particular acetazolamide. Fluid losses are replenished by the introduction of polyionic solutions.
When infectious toxic shock develops in the early stages, the main directions of drug treatment for meningococcal infection are:
- detoxification (forced diuresis regime - up to 6 l of fluid per day, for children - up to 100 ml/kg). Cryoplasm, 5-10% albumin solution, dextran, polyionic solutions, glucose-potassium mixture are used. Furosemide is administered simultaneously under the control of the hematocrit level and CVP. Moderate hemodilution regime is optimal (hematocrit is approximately 35%):
- stabilization of hemodynamics, combating microcirculatory disorders (dopamine in minimal doses, prednisolone - 3-5 mg/kg);
- combating hypoxia by inhaling oxygen through a mask or nasal catheters - up to 6 l/min;
- correction of metabolic acidosis and electrolyte disturbances (according to individual indications).
In the presence of arterial hypotension, norepinephrine at a dose of 0.5-1 mcg/kg per minute is indicated to stabilize arterial pressure. Then, dopamine or dobutamine are administered in individual doses necessary to maintain arterial pressure at the lower limits of the physiological norm. Correction of decompensated metabolic acidosis using sodium bicarbonate and other buffer solutions is mandatory. If oxygen therapy is insufficiently effective, patients are transferred to mechanical ventilation. If acute renal failure develops, the volumes of administered fluid and doses of medications excreted by the kidneys are adjusted. With the progression of cerebral edema-swelling, dexamethasone is prescribed at a dose of 0.15-0.25 mg/kg per day until consciousness is restored: oxygen therapy is performed. And with an increase in respiratory disorders and the development of coma, patients are transferred to mechanical ventilation in the mode of moderate hyperventilation (p a CO2> 25 mm Hg). In case of excitement and convulsions, diazepam, sodium oxybate, pyridoxine, and magnesium sulfate are prescribed. If convulsions cannot be stopped, sodium thiopental or hexobarbital are used. Water-electrolyte and metabolic disorders are also corrected, with hypernatremia being the most dangerous, which is corrected by replacing sodium-containing drugs (sodium oxybate, benzylpenicillin, etc.).
Care, adequate enteral-parenteral nutrition, prevention of nosocomial infections and trophic disorders are of great importance.
Regime and diet
In the generalized form of meningococcal infection, the regime is initially strict bed rest, then bed rest and ward rest. No special diet is required. In case of coma, mechanical ventilation - tube and/or parenteral nutrition.
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Clinical examination
The medical examination is carried out by a local therapist (pediatrician) and a neurologist for 1 year with visits at 1, 3, 6 and 12 months after discharge from the hospital.
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Patient information sheet
Patients who have had meningococcal infection should visit a doctor at the recommended intervals for at least 1-3 months, limit physical and mental stress as much as possible, avoid insolation (do not sunbathe!), alcohol consumption, salty foods (herring, pickles) for 1 year. Preschool children are not recommended to attend child care facilities for 3-6 months, schoolchildren - classes at school for 1-3 months after discharge, physical education classes - up to 1 year. Vacations and holidays should be spent in their climate zone.
What is the prognosis for meningococcal infection?
Mortality in the generalized form of meningococcal infection is 5-10% (up to 25% in non-specialized hospitals). The maximum mortality (up to 20-30%) is in children under one year of age and people over 60 years of age. In infectious toxic shock - 30-40%, in cerebral edema-swelling - 20-30%. This disease rarely becomes complicated if the diagnosis and treatment of meningococcal infection were timely. The most common causes of disability are hearing loss, hydrocephalic hypertensive syndrome.