A 22-year-old student has a fever, severe headache, neck stiffness and a non-blanching rash. He is in the GP surgery. What is the immediate action?

Answer and explanation

Correct answer: D. Give intramuscular benzylpenicillin or ceftriaxone if available, and arrange urgent hospital transfer by ambulance

  1. Step 1: This is suspected meningococcal sepsis.
  2. Step 2: NICE NG240 advises IM or IV ceftriaxone or benzylpenicillin as soon as possible outside hospital for strongly suspected meningococcal disease, without delaying transfer or waiting for investigations (unless there is severe allergy to both).
Answer
Give intramuscular benzylpenicillin or ceftriaxone if available, and arrange urgent hospital transfer by ambulance.
Why not the others: Prescribe oral amoxicillin and arrange a routine review in 48 hours: Oral antibiotics are inadequate. Take blood cultures and a lumbar puncture in the surgery and wait for the results: Waiting for cultures delays life-saving treatment. Reassure that the rash is viral and review him if he gets worse in two days: Review in two days is unsafe.

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