Abstract
Meningococcal disease is a fulminant infection with an overall mortality of 8%. Mortality is significantly increased with meningococcal septicaemia, particularly when there has been a delay in the diagnosis. The trend from 1985 to 1995 has been an increase in incidence of this disease, and the relative importance of meningococcal disease has also increased following a fall in the incidence of invasive Haemophilus influenzae disease with childhood immunisation. The management of such cases can be complex and time critical. Patients with meningococcal septicaemia often require aggressive resuscitation, including airway support, intravenous colloid, and parenteral antibiotics; hypoglycaemia is also commonly seen, and inotropes may be needed to support the circulation. We examine the treatment strategies in the early management of meningococcal disease and provide an algorithm for use by ambulance personnel, general practitioners, accident and emergency clinicians, and paediatricians. The objective of this algorithm is to ensure that an optimally resuscitated patient is delivered to the definitive care facility.
Full text
PDF
Images in this article
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Abman S. H., Griebel J. L., Parker D. K., Schmidt J. M., Swanton D., Kinsella J. P. Acute effects of inhaled nitric oxide in children with severe hypoxemic respiratory failure. J Pediatr. 1994 Jun;124(6):881–888. doi: 10.1016/s0022-3476(05)83175-0. [DOI] [PubMed] [Google Scholar]
- Burke D. P., Bowden D. F. Modified paediatric resuscitation chart. BMJ. 1993 Apr 24;306(6885):1096–1098. doi: 10.1136/bmj.306.6885.1096. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Cartwright K., Reilly S., White D., Stuart J. Early treatment with parenteral penicillin in meningococcal disease. BMJ. 1992 Jul 18;305(6846):143–147. doi: 10.1136/bmj.305.6846.143. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Klein N. J., Heyderman R. S., Levin M. Antibiotic choices for meningitis beyond the neonatal period. Arch Dis Child. 1992 Feb;67(2):157–159. doi: 10.1136/adc.67.2.157. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Paulson T. E., Spear R. M., Peterson B. M. New concepts in the treatment of children with acute respiratory distress syndrome. J Pediatr. 1995 Aug;127(2):163–175. doi: 10.1016/s0022-3476(95)70291-1. [DOI] [PubMed] [Google Scholar]
- Peltola H., Anttila M., Renkonen O. V. Randomised comparison of chloramphenicol, ampicillin, cefotaxime, and ceftriaxone for childhood bacterial meningitis. Finnish Study Group. Lancet. 1989 Jun 10;1(8650):1281–1287. doi: 10.1016/s0140-6736(89)92685-8. [DOI] [PubMed] [Google Scholar]
- Priestley B. L., Harrison C. J., Gerrard M. P., Gibson A. Paediatrics--Part II. Postgrad Med J. 1993 Apr;69(810):268–281. doi: 10.1136/pgmj.69.810.268. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Prober C. G. The role of steroids in the management of children with bacterial meningitis. Pediatrics. 1995 Jan;95(1):29–31. [PubMed] [Google Scholar]
- Rossaint R., Pappert D., Gerlach H., Falke K. Die Therapie des ARDS. Teil 2: Neue Behandlungsmethoden--erste klinische Erfahrungen. Anaesthesist. 1994 Jun;43(6):364–375. doi: 10.1007/s001010050069. [DOI] [PubMed] [Google Scholar]
- Schaad U. B., Lips U., Gnehm H. E., Blumberg A., Heinzer I., Wedgwood J. Dexamethasone therapy for bacterial meningitis in children. Swiss Meningitis Study Group. Lancet. 1993 Aug 21;342(8869):457–461. doi: 10.1016/0140-6736(93)91592-a. [DOI] [PubMed] [Google Scholar]
- Sinclair J. F., Skeoch C. H., Hallworth D. Prognosis of meningococcal septicaemia. Lancet. 1987 Jul 4;2(8549):38–38. doi: 10.1016/s0140-6736(87)93067-4. [DOI] [PubMed] [Google Scholar]