Speed of initiating treatment and accurate bacteriological diagnosis are the major factors determining the fate of the patient. When meningococcal disease is suspected (and unless the patient has a history of penicillin anaphylaxis) treatment with benzyl-penicillin should be started by the general practitioner before transfer to hospital; benefit to the patient outweighs the reduced chance of identifying the causative organism. Newly introduced diagnostic methods such as the Polymerase Chain Reaction (PCR) for bacterial DNA in CSF or blood enable accurate and rapid diagnosis even when the causative organisms have been destroyed by antibiotics.
Drugs must be given i.v. in high dose; the regimens below provide the recommended therapy, with alternatives for patients allergic to first choices. Intrathecal therapy is now considered unnecessary, and can be dangerous, e.g. encephalopathy with penicillin.
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