Meningococcal sepsis — RACGP Fellowship MCQ

Correct answer: A — Administer parenteral ceftriaxone if available and arrange urgent ambulance transfer

Explanation lettering: E = shown as A · C = shown as B · B = shown as C · A = shown as E

This child presents with meningococcal septicaemia in septic shock. The non-blanching purpuric rash is pathognomonic; combined with fever, drowsiness, tachycardia (150/min) and prolonged capillary refill (4 seconds, normal <2 seconds), this indicates haemodynamic compromise requiring emergency intervention. Australian primary care guidance is clear: if a non-blanching rash develops with features of meningococcal disease, immediate treatment and urgent hospital transfer are mandatory. Parenteral cephalosporin (ceftriaxone or cefotaxime) should be administered before transfer—not after arrival at hospital—as most deaths occur within 24 hours before specialist care. Option E is the only choice that combines immediate empiric antibiotic therapy (IV/IM ceftriaxone, the preferred agent) with emergency referral. Options A and B delay critical treatment; C and D mismanage the emergency by postponing or misdirecting therapy. The rash will not 'evolve' safely if left untreat, oral antibiotics are inadequate for septicaemia, investigations should not precede emergency treatment, and antihistamines are inappropriate and dangerous.

Reference: Royal Australian College of General Practitioners, Australian Family Physician Vol. 39, No. 5, May 2010: 'Meningococcal sepsis'; and Royal Children's Hospital Melbourne (2010). Australian Centre for Disease Control (2026) 'Invasive meningococcal disease'. Management principle: parenteral antibiotics before hospital transfer in primary care. https://www.racgp.org.au/afp/2010/may/meningococcal-sepsis