Therapeutic targets
- Elimination of the pathogens
- Prevention of multiple organ failure
Therapy recommendations
- If clinical suspicion is well-founded, start antibiosis (antibiotic therapy) immediately (penicillin G; first-line agent)
- Penicillin G does not lead to eradication of germs (“germ elimination“) in the nasopharynx (nasopharynx). Patients treated exclusively with this antibiotic should be treated supplementally with rifampicin (antibiotic from the series of tuberculostatics), ciprofloxacin (gyrase inhibitor ) or ceftriaxone (cephalosporins).
- Postexposure prophylaxis (PEP) [see below].
- See also under “Further therapy“.
Postexposure prophylaxis (PEP)
Meningococcal infection
Postexposure prophylaxis is the provision of medication to prevent disease in persons who are not protected against a particular disease by vaccination but have been exposed to it.
Indications (areas of application)
- Persons in close contact with a diseased person with invasive meningococcal infection (all serogroups), ie:
- All household members
- Persons in contact with a patient’s oropharyngeal secretions.
- Contact persons in children’s facilities with children under 6 years of age (if the group is well separated, only the affected group).
- Persons with close contacts in community facilities with household-like character (boarding schools, dormitories as well as barracks).
Implementation
- In persons who were in close contact with ill persons in the last 7 days before their onset of illness:
- Chemoprophylaxis (should be given as soon as possible after diagnosis in the index patient (first documented case of disease), but is useful up to 10 days after last exposure (“exposure”)):
- Rifampicin Neonates: 10 mg/kg/day in 2 ED p. o. for 2 days Infants, children, and adolescents up to 60 kg: 20 mg/kg/day in 2 ED p. o. for 2 days (maximum ED 600 mg) Adolescents and adults 60 kg and over: 2 x 600 mg/day for 2 days Eradication rate (number of cases in which therapy results in complete elimination of a pathogen): 72-90% or
- Ciprofloxacin from 18 years: once 500 mg p. o. Eradication rate: 90-95 % if necessary.
- Ceftriaxone from 2 to 12 years: 125 mg i. m. from 12 years: 250 mg i. m. in an ED Eradication rate: 97 %.
- In pregnant women, the administration of rifampicin and gyrase inhibitors is contraindicated (prohibited)! These receive for prophylaxis (prevention) if necessary ceftriaxone (250 mg once i.m.).
- Chemoprophylaxis (should be given as soon as possible after diagnosis in the index patient (first documented case of disease), but is useful up to 10 days after last exposure (“exposure”)):
- If the index patient’s infection was caused by serogroups A, C, W, Y, or B, post-exposure vaccination is recommended for unvaccinated household contacts or close contacts of a household-like nature in addition to chemoprophylaxis. Vaccination should be given as soon as possible after contact.
- For serogroup C: Vaccination with a conjugate vaccine; from the age of 2 months according to the specifications in the technical information.
- For serogroup A, W, Y: vaccination with 4-valent conjugate vaccine; if licensed for the age group.
After completion of therapy, the index patient with invasive meningococcal infection should also receive rifampicin unless treated intravenously (by vein) with a 3rd-generation cephalosporin.