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Clinical Practice Guidelines

Acute meningococcal disease

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    PIC Endorsed

  • See also:

    Meningitis and encephalitis
    Sepsis
    Fever and petechiae/purpura
    Local antimicrobial guidelines

    Key points

    1. IV ceftriaxone/cefotaxime should be given as soon as meningococcal disease is suspected. If unavailable, give benzylpenicillin
    2. If IV access cannot be obtained within 15 minutes, administer IM or via intraosseus
    3. Collect blood cultures prior to antibiotics if possible, but do not delay antibiotic administration

    Background

    • Acute meningococcal disease may present as severe sepsis with a progressive non-blanching petechial/purpuric rash, or meningitis with or without a rash
    • Rarer presentations include septic arthritis, pneumonia, pharyngitis and occult bacteraemia
    • There are 13 serogroups of Neisseria meningitidis (the cause of meningococcal disease) in Australia - the 5 most common are A, B, C, W and Y

    Assessment

    Red flags in red

    History

    • Rapid onset (<12 hours) of headache, loss of appetite, nausea, vomiting, sore throat and coryza
    • Fever
    • Infants may have reduced feeds, irritability
    • Leg pain or myalgia

    Examination

    • Signs of sepsis: see Sepsis
    • Abnormal skin colour (pallor or mottling) and/or cool peripheries
    • Late signs (>12 hours)
      • Altered conscious state
      • Neck stiffness, headache, photophobia, bulging fontanelle
      • Non-blanching rash: petechiae/purpura

    Note: a blanching rash does not exclude meningococcal disease (can initially be macular or maculopapular)

    Examples of rash: Click to see additional full size pictures

      blanching rash 1 blanching rash 2 


    Management

    Investigations

    Investigations should NOT delay antibiotic administration

    • Blood (or intraosseus):
      • Culture: should be obtained prior to antibiotic administration if possible.
      • PCR (separate EDTA tube, minimum volume 0.2 mL)
    • CSF (once initially stabilised and no contraindication to lumbar puncture): Gram stain (Gram negative diplococci), biochemistry, culture, and meningococcal PCR

    Treatment 

    Resuscitate as appropriate

    Antimicrobial recommendations may vary according to local antimicrobial susceptibility patterns; please refer to local guidelines

    Ceftriaxone 100 mg/kg (max 4 g) IV daily or

    Cefotaxime 50 mg/kg (max 2 g) IV 12 hourly (week 1 of life), 6-8 hourly (week 2-4 of life), 6 hourly (>week 4 of life)

    • If no IV/intraosseus access, give IM (may need two injections due to volume/muscle size and repeat the dose once IV access available)
    • If ceftriaxone/cefotaxime unavailable, administer benzylpenicillin 60 mg/kg IV 12 hourly (week 1 of life) 6 hourly (week 2–4 of life) 4 hourly (>week 4 of life) (max 2.4 g)

    Duration of antibiotics is 5 days

    If meningococcal infection is not yet confirmed treat as per Sepsis

    For additional management see Sepsis and Meningitis and encephalitis

    Ward management / other treatment considerations 

    Isolation
    Meningococcal disease is spread person-to-person by respiratory droplets.
    Patients should be isolated and droplet precautions continued for 24 hours after administration of appropriate antibiotics.

    Notification
    All cases of presumed or confirmed meningococcal disease require immediate notification to the local state authority:

    • NSW: Public Health Units of local Hospital & Health Service by telephone 1300 066 055 and PHU form
    • QLD: Public Health Units of local Hospital & Health Service by telephone ( list of PHUs )
    • VIC: Department of Human Services by telephone – 1300 651 160 ( DHHS notification procedure)
    • WA: Department of Health PHU

    Chemoprophylaxis
    Chemoprophylaxis should be given to contacts as soon as possible

    Vaccination

    • MenB vaccine
    • MenC vaccine
    • MenACWY (quadrivalent) vaccine

    Meningococcal B and ACWY immunisations are recommended as per the Australian Immunisation handbook. They are available on the National Immunisation Program (NIP)  for eligible children and also available for private purchase.

    Consider consultation with local paediatric team when

    All cases of suspected meningococcal disease in children.

    Consider transfer when

    All cases of acute meningococcal disease should be managed in a facility with the capacity to provide intensive care.
    If these facilities are unavailable, the patient should be stabilised and transferred as appropriate.

    For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

    Parent information

    Kids Health Info: Meningococcal Infection

    Last revised July 2020