About 2,500 cases of meningococcal infections are reported each year in the U.S; this infection carries a 10 percent fatality rate. The coffee bean-shaped bacteria, called Neisseria meningitidis (meningococci), which is responsible for the disease, is transmitted from person to person through coughing, sneezing and close contact. It is more prevalent in children and infants, and the symptoms include high fever, headache, vomiting, stiff neck and rash. Respiratory isolation of the patient along with early administration of antibiotics is key to managing and treating the disease.
Ceftriaxone
Ceftriaxone is a broad-spectrum antibiotic that can penetrate well into the meninges. Intravenous administration of high doses of the drug prevents the synthesis of mucopeptide in the bacterial cell wall, which leads to a defective cell wall and cell death. Mucopeptide is a polymer responsible for the structural rigidity of bacteria. Ceftriaxone, which is a third-generation cephalosporin, can treat meningococcal infections as well as nasopharyngeal carriage of the bacteria. Allergies are well documented for ceftriaxone. Individuals with renal impairment and women who are pregnant or nursing should take precautions when taking ceftriaxone. Patients taking probenecid for hyperuricemia may find increased levels of ceftriaxone in their blood.
Penicillin G
Penicillin G is less expensive than ceftriaxone and can successfully control meningococcal infection by inhibiting bacterial cell wall synthesis. Patients receive high doses of the antibiotic for one to two weeks. Penicillin, however, is not very effective in treating colonization of the bacteria in the upper respiratory tract. The effect of penicillin also decreases when the drug is administered along with another group of antibiotics called tetracycline. Probenecid, however, increases its effect. Penicillin allergies are common, and it can also cause renal impairment in rare cases.
Chloramphenicol
Chloramphenicol is the drug of choice to treat patients who are allergic to penicillin and ceftriaxone. It works by preventing protein synthesis in the bacterial cell. The antibiotic is given intravenously until the abatement of fever, after which it can be taken orally. Chloramphenicol may lead to toxic reactions when given with barbiturates and anticoagulants. It can also cause apalstic anemia in some cases; hence white blood cell levels should be monitored during the treatment.
Cefuroxime
When administered intravenously, this second-generation cephalosporin can prevent the growth of N. meningitidis by inhibiting cell wall synthesis. It can penetrate well into the cerebrospinal fluid (CSF) and is more effective than penicillin G and ceftriaxone in treating certain strains of meningococci that produce beta-lactamase. However, patients have reported allergic reactions to cefuroxime. It is also known to increase sensitivity to alcohol, if alcohol is consumed within 72 hours of taking the antibiotic. It can decrease the effect of anticoagulants and can lead to bacterial or fungal overgrowth of nonsusceptible organisms if used as prolonged therapy.
Rifampin
Rifampin is usually used to treat the upper respiratory tract carriage of meningococci and to prevent infections in persons who are in close contact with an infected individual. It can be taken orally, and it works by binding to a bacterial enzyme called RNA polymerase, thereby preventing bacterial cell multiplication. Rifampin is not suitable for pregnant women or for persons with active liver disease. It can reduce the effectiveness of birth control pills. Mild doses of oral ceftriaxone are prescribed in such cases.
References
- "Review of Medical Microbiology"; Patrick R. Murray, Ken Rosenthal; 2005
- MeningococcalDisease: Meningococcal Disease
- WHO: Meningococcal Meningitis
