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Meningococcal sepsis — DCH MCQ

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HardPaediatric emergenciesMeningococcal sepsisDCH

A 3-year-old boy is assessed in a GP surgery with fever, drowsiness and a rapidly spreading non-blanching purpuric rash. His heart rate is 170/min and capillary refill time is 4 seconds. He has no known severe beta-lactam allergy. An ambulance can depart in 10 minutes, and an intramuscular antibiotic can be administered immediately without delaying transfer. What is the most appropriate management?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Arrange immediate 999 transfer and give IV or IM ceftriaxone or benzylpenicillin now, without delaying departure

The correct answer is D. A rapidly spreading non-blanching purpuric rash, drowsiness, marked tachycardia and prolonged capillary refill strongly suggest meningococcal disease with circulatory compromise. NICE NG240 requires emergency hospital transfer and states that transfer must not be delayed to administer antibiotics. However, when meningococcal disease is strongly suspected, IV or IM ceftriaxone or benzylpenicillin should be given as soon as possible outside hospital unless this would delay transfer. Here it will not. B incorrectly applies the longer-transfer provision from general sepsis guidance instead of the meningococcal-specific recommendation. C delays definitive care, D provides inadequate oral treatment, and E incorrectly prioritises microbiological yield over time-critical treatment.

Reference: National Institute for Health and Care Excellence. NG240, Meningitis (bacterial) and meningococcal disease: recognition, diagnosis and management, section 1.2, recommendations 1.2.1–1.2.6. 2024. https://www.nice.org.uk/guidance/ng240/chapter/Recommendations