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Notification of updated guidance on antibiotic treatment of meningococcal disease cases

National Health Advisory

The Ministry of Health is informing you of changes to the recommended antibiotic treatment for suspected meningococcal infection in primary care and emergency departments.

The recommended treatment options are now as follows:

     Children Adults
 First choice  Ceftriaxone  100mg/kg IV (or IM) up to 2g  2g IV (or IM)
 Second choice  Benzyl-penicillin  50mg/kg IV (or IM) up to 2g  2.4g IV (or IM)


  • Early treatment of meningococcal infection is recommended, especially when there will be a delay for the patient to reach the Emergency Department.
  • Ceftriaxone is the preferred first-line treatment for all individuals.
  • If ceftriaxone is not available, benzyl-penicillin can be used. It is important to note that the treatment dose is higher than previously recommended.
  • Patients allergic to penicillin who do not have a documented history of anaphylaxis to penicillin can be given ceftriaxone.
  • There is no routine community treatment recommendation for patients with a documented history of anaphylaxis to penicillin.  These patients must be transferred immediately by ambulance to the closest hospital. This hospital should be made aware of the patient transfer. If you are in a remote location or at a significant distance from secondary care, or if there is any delay, you should seek urgent advice from an Infectious Disease Physician regarding treatment options prior to transfer to hospital.
  • IV administration is preferred to IM (where available and not leading to delays).


This advice has been provided following new information on lower susceptibility of Neisseria meningitidis to penicillin in New Zealand, and in consultation with the Australasian Society for Infectious Diseases (NZ ASID).


Last updated : Friday, December 07, 2018

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