In this section
This guideline has been adapted for statewide use with the support of the Victorian Paediatric Clinical Network
• IV antibiotics should be given as soon as meningococcal disease is suspected (if IV access cannot be obtained within 15 minutes, IM or IO administration is warranted)• If possible collect blood cultures prior to antibiotic administration • Ceftriaxone IV/IM or Cefotaxime IV is the first choice antibiotic. If unavailable, use penicillin IV/IM. • Other investigations should not delay antibiotic therapy.
Background to condition
Common presentations• Meningitis (see also meningitis guideline). • Meningococcaemia (classically fever + purpura but can be non-specific)Meningitis and meningococcaemia commonly occur together.
Less common presentations
History and Examination
Any child with meningococcal disease, including one who appears non-toxic, may deteriorate rapidly.
If possible blood culture should be obtained prior to, or very soon after, commencing antibiotics.
The other investigations should be obtained within the following hour if possible. These include:
Lumbar puncture would not be recommended in the initial management of an unwell child with fever and purpura. Lumbar puncture may be appropriate in suspected meningitis when no other contraindications exist
Gain intravenous access (or intraosseous access if IV not possible within 15 minutes).
Take blood (or marrow) for culture if possible and immediately administer Ceftriaxone (50mg/kg) or Cefotaxime (50mg/kg). See drug doses
Alternatively penicillin can be used if Ceftriaxone and Cefotaxime not available.
If shocked, give 20ml/kg normal saline. See Severe sepsis guideline
For meningitis alone, careful fluid management is important as many children have increased ADH secretion. See meningitis guideline.
Consider dexamethasone (0.15mg/kg IV) if undifferentiated meningitis. This should be administered within an hour of first antibiotics but should not delay antibiotics or fluids.
Isolate cases (if possible) until they have had >12 hours antibiotic treatment.
All cases of presumed or confirmed Neisseria meningitidis disease should be urgently notified to the Department of Human Services by telephone on 1300 651160 (fax 1300 651170) (after hours pager 03 9625 5000, pager number 46870).
It is important that prophylaxis be given within 24 hours to contacts.
Rifampicin causes orange-red discolouration of tears, urine and contact lenses, and may also cause skin rashes and itching, and gastrointestinal disturbance. It negates the effect of the oral contraceptive pill and should not be used in pregnancy, breastfeeding women, or severe liver or renal disease.
Out of hours: If medication is required after hours, a limited supply of Rifampicin pre-packaged 300 mg capsules and 20 mg/ml suspension is available in the PICU / Rosella medication room (cupboard below bench). The prescriber should complete details on the pack label, and a prescription should be left for collection by pharmacy.
Parent Information Sheet (Print version - PDF)
Parent Information Sheet (HTML version)
Information Specific to RCH - Including who to consult for inpatients.
All patients should be admitted under General Medicine.