A 5-year-old child develops high fever, extensive purpuric rash, and rapid deterioration over 12 hours. He has neck stiffness and petechiae spreading to the trunk. CSF shows neutrophilic pleocytosis, raised protein, and low glucose. Gram stain shows Gram-negative diplococci. Which antibiotic should be the FIRST choice when this diagnosis is suspected, even before CSF results, in a community setting?
- A IM benzylpenicillin or amoxicillin by the attending physician before transfer ✓
- B IV ceftriaxone 100 mg/kg/day
- C IV vancomycin until culture sensitivity is available
- D Oral amoxicillin-clavulanate while arranging emergency transport
Explanation
In suspected meningococcal meningitis/septicemia, if IV access cannot be immediately established in a community setting, IM benzylpenicillin (300 mg/kg/day, max 1.2 g single dose) should be given by the attending physician before hospital transfer — the benefit of treating early outweighs the small risk of interfering with cultures. In the hospital, IV ceftriaxone (third-generation cephalosporin) is the treatment of choice, providing empirical cover for Neisseria meningitidis, Streptococcus pneumoniae, and Haemophilus influenzae. Vancomycin is added when penicillin-resistant pneumococcus is suspected, not meningococcus.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.