Pre-hospital care of suspected meningitis or meningococcal septicaemia

First Line

Therapy

Benzylpenicillin IV, or IM

  • Child 1 - 11 months: 300 mg
  • Child 1 - 9 years: 600 mg
  • Child 10 - 17 years: 1.2 g

Or  Cefotaxime IV, or IM

  • Child 1 month–15 years: 50 mg/kg (max. per dose 2 g) for 1 dose, intramuscular doses over 1 g should be divided between more than one site.

Second line in documented Penicillin allergy

Therapy

Chloramphenicol PO or IV

  • Child >28 days: 25mg/ kg 

Notes

Meningococcal disease in its early stages is difficult to diagnose because many of the features are non-specific and the classical manifestations of meningococcal diseases are uncommon in primary care.

Invasive meningococcal disease generally presents in three illness patterns:

  • Meningococcal septicaemia ( approximately 20%): fever, petechiae, purpura and toxicity. Associated with a significantly poorer outcome.
  • Clinical meningitis:  fever, lethargy, vomiting, headache, photophobia, neck stiffness, and positive Kernig’s and Brudzinski’s signs. These are the classic features of established bacterial meningitis of any cause. Infants and young children may have less specific features, such as poor feeding, irritability, a high-pitched cry, and a full fontanelle. There may also be petechiae or purpura.
  • A mixed picture of septicaemia and meningitis.

If an ill child has a generalised petechial rash or purpuric rash, this is strongly suggestive of meningococcal septicaemia and the child should be referred to secondary care urgently. 

Additionally, any of the following features in an ill, febrile child should prompt consideration of a diagnosis of meningococcal infection: altered mental state, cold hands and feet, limb pain, headache, neck stiffness or skin mottling.

Within the first four to six hours of illness, meningococcal disease cannot be excluded as a potential diagnosis if young children present with non-specific symptoms.