9. TREATMENT OF PATIENTS WITH MENINGOCOCCAL DISEASE

MENINGOCOCCAL DISEASE IS A MEDICAL EMERGENCY AND TREATMENT SHOULD NOT BE DELAYED.

Pre-hospital treatment consists of antibiotics (ceftriaxone/cefotaxime) and fluid resuscitation of shocked patient before moving them from the primary care facility. Treatment should not be delayed due to difficulties in performing lumbar punctures, delays in neuro-imaging or unavailability of results. The choice of antibiotics is determined by their ability to adequately penetrate the cerebrospinal space and the susceptibility of the organism. The recommended first line drug of choice for proven meningococcal septicaemia or meningitis is IV benzyl penicillin for 5-7 days. However, wherever possible, ceftriaxone or cefotaxime should always be used for empiric therapy for suspected bacterial meningitis (Table 2). Patients with proven meningococcal meningitis and established significant beta-lactam allergy should receive chloramphenicol.

* Vancomycin should be added where high level penicillin resistance is anticipated (MIC≥2).

** Listeria monocytogenes is a relatively uncommon cause of bacterial meningitis in SA but should be considered. This organism is inherently resistant to cephalosporins and requires ampicillin ± gentamicin for effective treatment.