Practice patterns of infectious disease physicians for management of meningococcal disease.

Background: Although empiric treatment regimens for acute bacterial meningitis are well established, there are many uncertainties regarding management of meningococcal disease. A survey was conducted among infectious disease specialists to assess meningococcal disease practice patterns and availability of antimicrobial susceptibility testing for Neisseria menigitidis. Methods: An online survey was distributed to 1342 pediatric and adult infectious disease specialists to assess common practices and opinions regarding the diagnosis, treatment and prevention of meningococcal disease. Specialists were also asked about the availability of antimicrobial susceptibility testing for Neisseria meningitidis at their clinical microbiology laboratory. Results: Six hundred fifty members responded to the survey (48%). Pediatric infectious disease specialists were more likely than adult specialists to use penicillin as definitive therapy for meningococcal disease (56% versus 46%; P = 0.038). Most pediatric specialists who would narrow therapy report that they would only switch to penicillin upon confirmation of penicillin susceptibility (55%), although 44% would narrow therapy based on a N. meningitidis species confirmation alone. More than one third of respondents reported that susceptibility testing for N. meningitidis is not routinely performed. There was also wide variation in complement deficiency screening criteria and meningococcal disease chemoprophylaxis practices among respondents. Conclusions: Infectious disease specialists vary significantly in their practices regarding several aspects of meningococcal disease diagnosis, treatment and prevention. Antimicrobial susceptibility testing for N. meningitidis is not routinely performed in many practices. Consideration of these variations would be useful when developing treatment and prevention recommendations.