The Treatment of Acute Meningococcal Infection in Adults

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Abstract
Twenty-eight consecutive cases of acute meningococcal disease, 40% of which were variably resistant to sulfadiazine in-vitro were treated with penicillin as the sole antibacterial agent. Eleven cases presented with hypotension, pulmonary edema and gallop rhythm. Elevated central venous pressures were noted in 7 of these cases, suggesting that primary cardiac failure was a significant factor in the production of hypotension. Penicillin, used alone, proved as effective as previously employed sulfonamide and penicillin-sulfonamide combination with only 1 death in the 28 cases studied. Intravenous digitalis was effective in reducing central venous pressure and improving arterial pressure in 10 of 11 cases in which it was employed. In 3 cases with secondary increases in venous pressure and hypotension intravenous infusion of isoproterenol proved effective. It is concluded that penicillin is effective therapy for acute meningococ-cal disease, including those cases produced by sulfonamide resistant organisms. Primary cardiac failure is a major factor in the hypotension associated with acute meninogococcal septicemia. Therapy directed toward increasing cardiac output is effective in correcting this hypotension.