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Drug use in acute meningococcal disease
  1. K Cathie1,
  2. M Levin2,
  3. S N Faust1
  1. 1
    University of Southampton Wellcome Trust Clinical Research Facility, Southampton University Hospital NHS Trust, Southampton, UK
  2. 2
    Faculty of Medicine, Imperial College London, London, UK
  1. Dr Saul N Faust, University of Southampton Wellcome Trust Clinical Research Facility, Mailpoint 218, Level C West Wing, Southampton University Hospital NHS Trust, Tremona Road, Southampton, SO16 6YD, UK; s.faust{at}soton.ac.uk

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Meningococcal meningitis and septicaemia are systemic infections caused by the Gram negative diplococcus Neisseria meningitidis. Despite the recent success of the national vaccination programme against serogroup C disease, meningococcal septicaemia and meningitis remain frightening for both parents and clinicians. The advent of antimicrobial therapy in the last century reduced the mortality rate from 20% to 10%,1 2 but overall mortality has not fallen further since the mid-1990s when aggressive resuscitation and paediatric intensive care became an accepted standard of care. The death rate in children with meningococcal disease admitted to paediatric intensive care units (PICU) in the UK between 2004 and 2006 was 5.9%.3 This article considers the conventional and experimental therapies used in meningococcal disease, it focuses on treatment rather than prevention and concentrates on the drugs available to those working in high income countries (fig 1).

Figure 1 A patient’s journey. FFP, fresh frozen plasma; IV/IO, intravenous/intraosseous; PICU, paediatric intensive care unit.

In the UK there are about 1500 laboratory confirmed cases of meningococcal disease every year (table 1), but it is thought that there may be up to 5000 cases in total.4 In the US there were 1194 notified cases in 2006 and 974 in 2007.5

View this table:
Table 1 Laboratory confirmed cases of invasive meningococcal disease in the UK in 2006 and 2007

TREATMENT

Drugs used in both meningococcal septicaemia and meningococcal meningitis

Antibiotics used in pre-hospital care

Early recognition of meningococcal disease is important as children can deteriorate quickly. Once a case of meningococcal disease is suspected, pre-hospital treatment with benzyl penicillin is recommended in the UK.7 It is generally believed that the bacteria are in a phase of rapid growth in the blood stream of patients presenting to health care, and even a few hours’ delay may result in increased bacterial load. An alternative view is that bactericidal antibiotics may cause a rapid release of endotoxin and thus increase the severity of the disease. However, studies of endotoxin levels following penicillin administration have not shown any increase associated with antibiotic administration.8 Nevertheless, there is also …

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