Synopsis
Recognise fulminant pneumococcal and meningococcal sepsis or meningitis, start immediate ceftriaxone-based treatment, secure microbiological confirmation, notify health protection and prevent secondary meningococcal cases.
- Meningococcal disease may present as septicaemia, meningitis or both; pneumococcus commonly causes meningitis, bacteraemic pneumonia and overwhelming sepsis.
- Absence of rash does not exclude meningococcal disease, and a blanching early rash can evolve into purpura as coagulopathy develops.
- Give ceftriaxone immediately for suspected invasive disease after cultures when this causes no material delay; use meningitis dosing when CNS infection is possible.
Key red flags
A non-blanching rash with fever or toxicity is meningococcal disease until urgent assessment proves otherwise.
Abrupt fever, severe myalgia, limb pain, mottling, purpura, shock and rapid capillary leak may occur before meningism.
Investigation priorities
Confirm viable organism and preserve diagnosis after prior antibiotics.
Management branches
Invasive meningococcal or pneumococcal disease is clinically suspected.
- Use ABCDE, capillary refill, lactate, urine output and neurological examination and involve critical care early for shock or altered consciousness.
- Take blood culture and PCR quickly, then give ceftriaxone at meningitis dose when CNS infection cannot be excluded.
Key medicines
Ceftriaxone for suspected invasive meningitisGive ceftriaxone 2 g intravenously every 12 hours in adults when bacterial meningitis is suspected.
Ceftriaxone for non-meningeal invasive infectionGive ceftriaxone 2 g intravenously once daily when invasive disease is severe but meningitis has been excluded.