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How is meningococcal infection treated?
Last reviewed: 23.04.2024
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Medication for meningococcal infection
Treatment of meningococcal infection depends on the clinical form of the disease. With nasopharyngitis, therapy is symptomatic. If the diagnosis is confirmed bacteriologically, use benzylpenicillin, ampicillin, cephalosporins I-II generation, chloramphenicol, pefloxacin in average therapeutic doses for 3 days. Do not use co-trimoxazole, aminoglycosides, to which most of the currently existing meningococcal strains are stable.
Patients or persons with a presumptive diagnosis of a generalized form of meningococcal infection are subject to emergency hospitalization in specialized departments of infectious hospitals.
The drug of choice for the treatment of generalized forms of meningococcal infection is benzylpenicillin, to which almost all strains of meningococcus are sensitive. Penicillin is prescribed in a daily dose of 200-300 thousand units / kg, single doses are administered with an interval of 4 hours. With intravenous administration, the daily dose is increased to 300-400 thousand units / kg. With late admission, meningoencephalitis is advisable to increase the dose to 400-500 thousand units / kg.
Highly effective ceftriaxone, which has a pronounced antimicrobial activity and a satisfactory passage through the BBB. Adults appoint him to a dose of 4 grams once, to children - 100 mg / kg, but not more than 4 g / day. Effective also isefotaksim at a dose of 200 mg / kg (not more than 12 g / day).
Chloramphenicol is also used in 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, so in the period of treatment, situations where the concentration of these drugs can decrease below the therapeutic and bactericidal effect can not be achieved. In this regard, penicillin has an advantage due to very low toxicity, absence of nephrotoxic and hepatotoxic effect, the dose can be increased up to 500 thousand units / kg and more.
Antimicrobial treatment of meningococcal infection depends on the time of sanation of the cerebrospinal fluid and is from 5 to 10 days. It was found that when the cytosis is lower than 100 in 1 μl (and in children under the age of less than 50 in 1 μl) and the number of neutrophils is less than 30% in meningococcal meningitis, the cerebrospinal fluid is sterile.
Detoxification therapy for uncomplicated generalized forms of the disease is carried out 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 goal of which is to reduce the edema of the brain and intracranial hypertension by mobilizing fluid from the subarachnoid space and brain substance. The most effective furosemide in a daily dose of 20-40 mg, maximum - 80 mg, children - up to 6 mg / kg. Intensive dehydration in the normovolemia regime is performed in the first 5-7 days, then weaker diuretics are used. In particular acetazolamide. Loss of fluid is replenished by the introduction of polyionic solutions.
With the development of infectious-toxic shock in the early stages, the main areas of drug treatment for meningococcal infection are:
- detoxification (the regime of forced diuresis - up to 6 liters of fluid per day, children - up to 100 ml / kg). Apply cryoplasm, 5-10% albumin solution, dextran, polyionic solutions, glucose-potassium mixture Furosemide is simultaneously administered under the control of the level of hematocrit and CVP. The mode of moderate hemodilution is optimal (hematocrit is approximately 35%):
- stabilization of hemodynamics, control of microcirculatory disorders (dopamine in minimal doses, prednisolone - 3-5 mg / kg);
- fight against hypoxia by inhalation of oxygen through a mask or nasal catheters - up to 6 l / min;
- correction of metabolic acidosis and electrolyte disturbances (ps to individual indications).
In the presence of arterial hypotension, the administration of noradrenaline in a dose of 0.5-1 μg / kg per minute is shown to stabilize blood pressure. Later on, they switch to the administration of dopamine or dobutamine in individual doses necessary to maintain blood pressure at the lower limits of the physiological norm. Correction of decompensated metabolic acidosis with sodium bicarbonate and other buffer solutions is mandatory. With insufficient effectiveness of oxygen therapy, patients are transferred to mechanical ventilation. With the development of acute renal failure, correction of the volumes of the injected fluid and the doses of medications excreted by the kidneys are performed. With the progression of edema-swelling of the brain, dexamethasone is administered at a dose of 0.15-0.25 mg / kg per day until consciousness is restored: oxygene therapy is performed. And with the growth of 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). When excited, as well as convulsions prescribed diazepam, sodium oxybate, pyridoxine. Magnesium sulfate. If seizures can not be cured, use sodium thiopental or hexobarbital. Correction of water-electrolyte and metabolic disturbances is also carried out, the most dangerous is hypernatremia, which is corrected by replacing sodium-containing drugs (sodium oxybate, benzylpenicillin, etc.).
Of great importance are care, full enteral-parenteral nutrition, prevention of nosocomial infection and trophic disorders.
Diet and diet
In the generalized form of meningococcal infection, the regime is at first a strict bed rest, later - bed and ward. A special diet is not required. When coma, carrying out ventilation - probe and / or parenteral nutrition.
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Clinical examination
A district therapist (pediatrician) and a neurologist are provided with a prophylactic medical examination for 1 year with a turnout at 1, 3, 6 and 12 months after discharge from the hospital.
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Reminder for patient
Patients who have had a meningococcal infection should visit the doctor within the recommended time frame for at least 1-3 months, limit physical and mental stress as much as possible, avoid sun exposure (not sunbathe) for 1 year, drink alcohol, salt food (herring, pickled cucumbers ). Children of preschool age are not recommended to visit children's institutions for 3-6 months, schoolchildren - classes in the school for 1-3 months after discharge, physical education - up to 1 year. Holidays, vacations should be conducted in its climatic zone.
What prognosis does meningococcal infection have?
Mortality in the generalized form of meningococcal infection is 5-10% (up to 25% in non-core hospitals). Maximum mortality (up to 20-30%) in children under the age of one and over 60 years of age. With infectious-toxic shock - 30-40%, with edema-swelling of the brain - 20-30%. This disease is rarely complicated if the diagnosis and treatment of meningococcal infection were timely. The most common causes of disability are hearing loss, hydrocephalus-hypertensive syndrome.