Management: General

All children with suspected meningococcal disease in the ED should be managed in the presence of full resuscitation facilities, with continuous cardiac and oxygen saturation monitoring. A senior emergency physician and the duty paediatrician should be involved at an early stage.

Oxygen should be administered to children with signs of respiratory distress, and an anaesthetist immediately involved if there is any concern about the childs ability to maintain their own airway and adequately self-ventilate.

Two wide bore intravenous cannulae should be inserted, and where possible appropriate blood tests should be collected at this stage (see investigations). Intraosseous access should be used where intravenous access is not gained within an appropriate timescale (APLS recommends three attempts or 90 seconds).

If there are signs of shock, give an immediate fluid bolus of 20ml/kg sodium chloride 0.9% (or alternative balanced crystalloid) over 5-10 minutes and reassess. If signs of shock persist, a second and then a third bolus of either crystalloid or human albumin 4.5% solution are recommended.

If signs of shock persist after the first 40ml/kg, urgent anaesthetic and intensive care assistance should be sought to consider intubation and initiation of vasoactive drugs, together with further boluses of fluid based on the clinical and biochemical picture.

Empirical intravenous antibiotics are the mainstay of treatment in all children with invasive meningococcal disease. NICE guidelines recommend cefotaxime (50mg/kg) and amoxicillin/ampicillin (to cover listeria see BNF) in children under 3 months old, and ceftriaxone (80mg/kg) in children over 3 months old [4].