Suspected Meningococcal Disease

Comments from Expert Advisory Committee

  • Transfer all patients to hospital immediately by the quickest route possible which may include ambulance transfer.
  • Administer benzylpenicillin as soon as possible. Ideally intravenously, if a vein cannot be found administer intramuscularly. Benzylpenicillin should be withheld only if an individual has a proven history of penicillin anaphylaxis. In the extremely rare case of history of anaphylactic reaction to penicillin, the highest priority is to get the patient to hospital.
  • GPs or advanced paramedics are not expected to carry an alternative antibiotic to benzylpenicillin. However, if available, a third generation cephalosporin (cefotaxime or ceftriaxone) can be used and is an acceptable alternative to benzylpenicillin for the empirical treatment of suspected meningococcal disease prior to transfer to hospital.
  • Prevention of secondary case of meningitis: Only prescribe following advice from Public Health Doctor.


Drug Dose Duration  Notes
  • Reconstitution advice for the parenteral preparation has been provided in the right hand column.
  • Injection IV is recommended slowly (3-5mins) for all agents listed to minimise discomfort and pain at injection site.
  • Water for Injection (WFI) and Sodium Chloride 0.9% Injection (NS) have been abbreviated.
1st choice options (unless proven history of penicillin anaphylaxis)

IV or IM Benzylpenicillin



<1 year: 300mg

1 – 9 years: 600 mg

Adults and children ≥10 years: 1200 mg

STAT prior to admission to hospital



For IV Administration:

600 mg dissolved in 4- 10 ml WFI or NS.

For IM Administration:
600 mg dissolved in 1.6 to 2.0 ml of WFI


Alternative options (unless proven history of penicillin anaphylaxis)

Doses greater than 1g should be divided and injected at more than one site

IV or IM Cefotaxime




Adults and children (all ages):

50 mg/kg/dose, max 2g


STAT prior to admission to hospital



For IV Administration:
1g dissolved in 4mL WFI


For IM Administration:
1g dissolved in 4mL WFI

IV or IM Ceftriaxone






Adults and children 15 days*:

80 mg/kg/dose, max 2g




STAT prior to admission to hospital





*Contraindicated in neonates 0‑14 days and premature neonates up to a postmenstrual age of 41 weeks (gestational age + chronological age).

For IV Administration:
Each 1g dissolved with 10mL WFI.

For IM Administration:
Each 1g vial dissolved with 3.5mL of 1% lidocaine hydrochloride injection to reduce pain at injection site. Do NOT give lidocaine IV.

Patient Information

Safe Prescribing (visit the safe prescribing page)

Reviewed December 2022

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