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Emergency management of meningococcal disease: eight years on
  1. Andrew J Pollard1,
  2. Simon Nadel2,
  3. Nelly Ninis2,
  4. Saul N Faust3,
  5. Michael Levin2
  1. 1Department of Paediatrics, University of Oxford, Oxford, UK
  2. 2Department of Paediatrics, Imperial College School of Medicine, St Mary’s Hospital, London, UK
  3. 3Wellcome Trust Clinical Research Facility, University of Southampton, Southampton, UK
  1. Correspondence to:
    Dr Andrew J Pollard
    Department of Paediatrics, University of Oxford, Level 2, children‘s Hospital, Oxford OX3 9DU, UK; andrew.pollard{at}

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Application of the new edition of the meningococcal treatment algorithm may help in the early management of critically ill patients

In 1999, our personal practice article, “Emergency management of meningococcal disease” was printed in this journal1 and, although the journal considered publishing such personal practice statements to be unfashionable,2 it was mostly well received and has since been cited over 60 times.

In the original article, we proposed an algorithm for identifying management priorities in treating patients with meningococcal disease, on the basis of our experiences of 425 cases and on the available published evidence wherever possible. During, the past 8 years, over 51 000 copies of the algorithm have been disseminated to accident and emergency departments, intensive care units and paediatric units in the UK and elsewhere by the charity Meningitis Research Foundation. The algorithm has also appeared in several other articles, book chapters and a handbook for junior doctors (35 000 copies distributed and now available at It has now been revised for the fifth time and the updated version is included with this perspective (fig 1). Furthermore, a version of the algorithm modified for the management of adults with meningococcal disease has been published3 and an interactive tool designed for education of junior doctors (see

Figure 1

 Algorithm: Early Management of Meningococcal Disease n Children, 5th edition. Copies of the algorithm are available from the Meningitis Research Foundation (

Several changes have been made since the 1999 edition of the algorithm was published. We still advocate the use of 4.5% human albumin solution as the fluid for volume resuscitation in meningococcal disease in view of the low mortality that we have observed when using this fluid.4 The safety of the use of albumin solution in adults has been confirmed in …

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