Treatment of meningococcal infection

Antibacterial therapy for meningococcal infection

For generalized meningococcal infection, penicillin therapy with large doses remains effective. Benzylpenicillin potassium salt is administered intramuscularly at a rate of 200,000-300,000 U/kg per day. For children aged 3-6 months, the dose is 300,000-400,000 U/kg per day. The daily dose is administered in equal parts every 4 hours without a night break. For children in the first 3 months of life, it is recommended to shorten the intervals to 3 hours.

In severe cases of meningoencephalitis, and especially ependymitis, intravenous benzylpenicillin is indicated. A clear clinical effect is observed within 10-12 hours of starting penicillin treatment. Reducing the penicillin dose is not recommended until the full course is completed (5-8 days). By this time, the general condition improves, body temperature returns to normal, and meningeal symptoms resolve.

While penicillins are effective in treating meningococcal infections, preference should currently be given to the cephalosporin antibiotic ceftriaxone (Rocephin), which penetrates well into the cerebrospinal fluid and is slowly eliminated from the body. This allows for its administration to be limited to once or twice daily at a maximum dose of 50-100 mg/kg per day.

To monitor the effectiveness of antibiotic treatment, a lumbar puncture is performed. If the fluid cytosis does not exceed 100 cells/mm3 ^and is lymphocytic, treatment is discontinued. If pleocytosis remains neutrophilic, antibiotic administration should be continued at the previous dose for another 2-3 days.

Combining two antibiotics is not recommended, as it does not improve treatment effectiveness. Combined antibiotic use should only be considered in the case of a bacterial infection (staphylococcus, proteus, etc.) or the development of purulent complications, such as pneumonia, osteomyelitis, etc.

If necessary, sodium succinate (chloramphenicol) can be prescribed at a dose of 50-100 mg/kg per day. The daily dose is administered in 3-4 divided doses. Treatment is continued for 6-8 days.

Symptomatic therapy of meningococcal infection

Along with etiotropic therapy for meningococcal infection, a range of pathogenetic measures is administered to combat toxicosis and normalize metabolic processes. For this purpose, patients are provided with an optimal amount of fluids through drinking and intravenous infusions of 1.5% reamberin solution, rheopolyglycin, 5-10% glucose solution, plasma, albumin, and other substances. Fluids are administered intravenously at a rate of 50-100-200 mg/kg per day, depending on age, severity of the condition, fluid and electrolyte balance, and renal function. Donor immunoglobulin is also indicated, and probiotics (Acipol, etc.) are prescribed.

In very severe cases of meningococcemia associated with acute adrenal insufficiency syndrome, treatment should begin with intravenous fluid administration (eg, hemodez, rheopolyglucin, 10% glucose solution) until a pulse appears, followed by hydrocortisone (20-50 mg). The daily glucocorticoid dose can be increased to 5-10 mg/kg prednisolone or 20-30 mg/kg hydrocortisone. Once a pulse appears, fluid administration should be switched to intravenous drip.