Neisseria meningitidis

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See meningitis for a general approach to the disease entity

Background

Clinical Features

Epidemic meningitis geographic distribution showing "meningitis belt."
Severe meningococcal meningitis with classic petechial rash progressing to gangrene.
  • A cause of meningitis
  • Rash
    • Approximately 2/3 of patients with meningococcemia develop rash.[1]
    • Can include erythematous, morbilliform, or urticarial macules and papules[2]
    • Most common hallmark is purpuric lesions with jagged edges. [3]

Post exposure prophylaxis

  • Ceftriaxone 250mg IM once (if less than 15yr then 125mg IM)
  • Ciprofloxacin 500mg PO once
  • Rifampin 600 mg PO BID x 2 days
    • if < 1 month old then 5mg/kg PO BID x 2 days
    • if ≥ 1 month old then 10mg/kg (max at 600mg) PO BID x 2 days

Antibiotic Sensitivities[4]

Category Antibiotic Sensitivity
Penicillins Penicillin G S
Penicillin V R
Anti-Staphylocccal Penicillins Methicillin R
Nafcillin/Oxacillin R
Cloxacillin/Diclox. R
Amino-Penicillins AMP/Amox S
Amox-Clav S
AMP-Sulb S
Anti-Pseudomonal Penicillins Ticarcillin S
Ticar-Clav S
Pip-Tazo S
Piperacillin S
Carbapenems Doripenem S
Ertapenem S
Imipenem S
Meropenem S
Aztreonam S
Fluroquinolones Ciprofloxacin S
Ofloxacin S
Pefloxacin S
Levofloxacin S
Moxifloxacin S
Gemifloxacin X1
Gatifloxacin S
1st G Cephalo Cefazolin R
2nd G. Cephalo Cefotetan I
Cefoxitin I
Cefuroxime S
3rd/4th G. Cephalo Cefotaxime S
Cefizoxime I
CefTRIAXone S
Ceftaroline S
CefTAZidime I
Cefepime S
Oral 1st G. Cephalo Cefadroxil R
Cephalexin R
Oral 2nd G. Cephalo Cefaclor/Loracarbef I
Cefproxil I
Cefuroxime axetil I
Oral 3rd G. Cephalo Cefixime I
Ceftibuten I
Cefpodox/Cefdinir/Cefditoren X1
Aminoglycosides Gentamicin R
Tobramycin R
Amikacin R
Chloramphenicol S
Clindamycin R
Macrolides Erythromycin X2
Azithromycin X2
Clarithromycin X1
Ketolide Telithromycin X2
Tetracyclines Doxycycline S
Minocycline S
Glycylcycline Tigecycline X1
Daptomycin R
Glyco/Lipoclycopeptides Vancomycin R
Teicoplanin R
Telavancin R
Fusidic Acid S
Trimethoprim I
TMP-SMX X2
Urinary Agents Nitrofurantoin X1
Fosfomycin X1
Other Rifampin S
Metronidazole R
Quinupristin dalfoppristin R
Linezolid R
Colistimethate R

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

Table Overview

See Also

References

  1. Sara Bode; Contagious Exanthematous Diseases. Quick References 2022; 10.1542/aap.ppcqr.396150
  2. Sara Bode; Contagious Exanthematous Diseases. Quick References 2022; 10.1542/aap.ppcqr.396150
  3. Sara Bode; Contagious Exanthematous Diseases. Quick References 2022; 10.1542/aap.ppcqr.396150
  4. Sanford Guide to Antimicrobial Therapy 2014