Suspected meningococcal disease prior to admission into secondary care (Antimicrobial)
TAM (Treatments and Medicines) NHS Highland
What's new / Latest updates
April 2025 (V2):
- Added: NICE NG240 published 19 March 2024
- Added: 'Note intravenous ceftriaxone is contra-indicated with intravenous calcium containing fluids in premature and full term neonates. NICE recommendation to use ceftriaxone first line is based on duration of action and cost. Cefotaxime remains a suitable alternative. In an emergency, the antibiotics can be given via the intra-osseous route. See NHS Highland Hospital Paediatrics section (NHS Highland intranet access required)'
- Information on IV or IM ceftriaxone expanded to include doses by child age and weight of 50kg and over removed.
- Added: 'The actual dose given should be communicated to the receiving hospital, where the child’s weight should be obtained as soon as possible and the remainder of the dose given if necessary'.
Overview | Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management | Guidance | NICE NG240 published 19 March 2024
Note intravenous ceftriaxone is contra-indicated with intravenous calcium containing fluids in premature and full term neonates.
NICE recommendation to use ceftriaxone first line is based on duration of action and cost. Cefotaxime remains a suitable alternative.
In an emergency, the antibiotics can be given via the intra-osseous route. See NHS Highland Hospital Paediatrics section (NHS Highland intranet access required).
For glossary of terms see Glossary.
Drug details
IV or IM Ceftriaxone
Adults and children from age 9: 2 grams
Child under 50kg: 80mg/kg
Child under 9 - as per BNFC:
- Up to 1 month: 250mg
- 2 to 11 months: 500mg
- 1 to 4 years: 1 gram
- 5 to 8 years: 1.5 grams
Give IM if vein cannot be found.
The actual dose given should be communicated to the receiving hospital, where the child’s weight should be obtained as soon as possible and the remainder of the dose given if necessary.
Alternative
IV or IM Benzylpenicillin
Adults and children 10 years and over: 1200mg
Children 1 to 9 years: 600mg
Children under 1 year: 300mg
Give IM if vein cannot be found.
If ceftriaxone contra-indicated (see BNFC and not above)
IV or IM Cefotaxime
Adults: 2 gram
Children 12 to 17 years: 1 gram
Children 1 month to 11 years: 50mg/kg
Give IM if vein cannot be found.
Administer intramuscular doses above 1 gram over more than one site .
Penicillin/cephalosporin anaphylaxis
Await admission to hospital before administering antibiotics - contact infection specialist.