Menningococcal Septacaemia

[hertzvanrental]

Just wondering what you guys do for patients who present with possible menningococcal septacaemia. Are there any EMS services who carry anti biotics in the states. We have been using Benzylpenicillin here in the UK for the last few years. I had a few patients with this, mainly kids. We can give it I.M, I.V and I.O.

[Kaisu]

We administer no antibiotics prehospital. I don't know of any service that carries any.

[akflightmedic]

Alaska is the only state where I carried and administered antibiotics prehospitally.

I also did antibiotic therapy in the Philippines under my Oregon license and of course over here in the desert it is common but we are not under any state guidelines here.

[Timmy]

Ceftriaxone IV or IM

[jmac]

we give the benz here pre-hosp as well

[Doczilla]

Meningococcus has taken a back seat to strep pneumo as a cause of most cases of meningitis since the vaccine is in fairly wide use, though it still has a hold on the young (59% of cases of children and young adults). It is extremely unlikely in the US that the causative pathogen will be known upon initial presentation, since strep pneumo and n. meningitidis are so prevalent. Viruses, particularly herpes, can do it too. The problem with meningitis is that if it is clinically evident without doing the LP, likely the patient is in extremely deep s#it.

I have to emphasize the role of steroids in these patients, which should be administered with the first dose of antibiotics. Steroids will dampen the inflammatory cascade that comes with bacteria dying in droves with the first dose of antibiotics, and reduces morbidity and mortality.

Our standard regimen here is decadron (dexamehtasone 10mg) + rocephin (ceftriaxone 2g) + vancomycin (1g) + acyclovir (800-1000mg) +/- ampicillin depending on age. Decadron and rocephin can be given IV push, or even IM if you have serious vascular access problems. Vancomycin should not be given IV push, nor acyclovir. Acyclovir is fairly harmless as a drug, so giving it is possibly helpful and extremely rarely harmful. If the patient is in certain populations, they should be given ampicillin as well to cover listeria (very young and very old). If the have HIV, they get everything as well as an antifungal agent.

There are no EMS services in the state of Ohio that give antibiotics prehospital by paramedics (though physicians do) unless it is a "declared emergency", i.e., WMD or pandemic or serious public heath breakdown. This is by state law.

'zilla

[rat115]

Here, we don't do much prehospital besides IV fluids and o2. The biggest push here is to make sure it's identified and contained because things run throught the schools here at an alarming rate.

[aussiephil]

We use Benzly Penecillin here combined with fluid therapy & O2.

However, there is also an emphasis on givving the drug rather than with holding it. Because the signs & symptoms are so broad & nodescript, we are free to use it 'if it is suspected".

[Dustdevil]

I have worked two services in Texas where we administered IV antibiotics, however they were only for trauma. As Zilla points out, it would be extremely uncommon for EMS to pick up a patient in the field that presented so clearly that an empirical diagnosis of meningococcaemia could be comfortably made. I don't know how such a thing could really work out in EMS. Every kid with febrile BOM would end up full of Rocephin, which would be a very bad thing. The signs are obviously clearer in adults, but still certainly not an easy empirical call, and the gravity of the situation certainly wouldn't necessitate immediate treatment versus a simple fifteen minute ride to the hospital.

[jmac]

ok, don't really like to comment here but lets just say have to say something, better minds then mine outside of the states that are attached to medicines advisery groups have stated passed and allowed the use of IV antibiotics for "suspected" cases, as phil said better to get it then wait.

Dust, some cases are more then a 15 min ride to hospital, while the use of steroids as doc says is great, benzy and fluids is all that we are permitted, what i cant understand is those that seem to advocate better education in a system seem to go out of their way sometimes to downplay advances in other systems, this is not an attack on any individuals, just a sit back and watch, in our case, it better to have it and give it then not have it and ponder, hey its up to the labs to diagnose anyway.