What is the recommended prophylaxis regimen for meningitis exposure in Nigeria?

From the Guidelines

For meningitis exposure prophylaxis in Nigeria, the recommended regimen is ciprofloxacin as a single 500 mg oral dose for adults, as stated in the guideline by the UK joint specialist societies 1. Children should receive weight-appropriate dosing: 250 mg stat for child contacts aged 5-12 years, and 30 mg/kg up to a maximum of 125 mg stat for child contacts under 5 years, as recommended by the same guideline 1. Alternatively, rifampicin can be given as an alternative, with dosing regimens of 600 mg twice a day for 2 days for contacts over the age of 12,10 mg/kg twice a day for 2 days for contacts aged 1-12 years, and 5 mg/kg twice a day for 2 days for contacts aged less than 12 months, as stated in the guideline 1. Prophylaxis should be given as soon as possible after exposure, ideally within 24 hours. Close contacts of confirmed cases, including household members, dormitory roommates, and those with direct contact with the patient's oral secretions, should receive prophylaxis. This preventive treatment works by eliminating nasopharyngeal carriage of Neisseria meningitidis, the bacterium responsible for meningococcal meningitis, which is particularly prevalent in Nigeria's "meningitis belt." Some key points to consider when administering prophylaxis include:

• The importance of prompt administration, ideally within 24 hours of exposure, to prevent secondary cases, as highlighted in the ESCMID guideline 1.
• The need to consider alternative prophylaxis regimens, such as rifampicin, in cases where ciprofloxacin is contraindicated, as stated in the UK joint specialist societies guideline 1.
• The role of vaccination campaigns in providing longer-term protection, particularly in outbreak situations, as mentioned in the UK joint specialist societies guideline 1. In terms of specific dosing regimens, the following are recommended:
• Ciprofloxacin: 500 mg oral dose for adults, as stated in the ESCMID guideline 1.
• Rifampicin: 600 mg twice a day for 2 days for contacts over the age of 12, as stated in the UK joint specialist societies guideline 1.
• Ceftriaxone: 250 mg intramuscular injection for adults, or 125 mg for children under 12 years, as stated in the ESCMID guideline 1. It is essential to note that prophylaxis is most effective when administered promptly to all close contacts, as secondary cases often occur within the first week after exposure to the index case, as highlighted in the UK joint specialist societies guideline 1.

From the FDA Drug Label

For adults, it is recommended that 600 mg rifampin be administered twice daily for two days Pediatric patients 1 month of age or older: 10 mg/kg (not to exceed 600 mg per dose) every 12 hours for two days.

The recommended prophylaxis regimen for meningitis exposure is Rifampin.

• Adults: 600 mg twice daily for 2 days
• Pediatric patients 1 month of age or older: 10 mg/kg every 12 hours for 2 days (not to exceed 600 mg per dose)
• Pediatric patients under 1 month of age: 5 mg/kg every 12 hours for 2 days 2

From the Research

Meningitis Post-Exposure Prophylaxis in Nigeria

• The recommended prophylaxis regimen for meningitis exposure in Nigeria is not explicitly stated in the provided studies, but the effectiveness of different antibiotics for prophylaxis against meningococcal disease can be considered 3, 4, 5, 6.
• Ciprofloxacin, rifampin, minocycline, and penicillin have been shown to be effective in eradicating N. meningitidis one week after treatment when compared with placebo 3, 4, 5, 6.
• Rifampin, ciprofloxacin, and penicillin still proved effective at one to two weeks, while rifampin was effective compared to placebo up to four weeks after treatment 3, 4, 5, 6.
• Ceftriaxone was more effective than rifampin after one to two weeks of follow-up, and its use should be considered, especially in outbreak settings where rifampin resistance may be a concern 3, 4, 5, 6.
• Azithromycin has also been shown to be effective in eradicating meningococcal colonization and may be an alternative agent for post-exposure prophylaxis, with the advantage of easier application and lower toxicity 7.

Antibiotic Effectiveness

• The following antibiotics have been shown to be effective in preventing meningococcal infections:

• Ciprofloxacin
• Rifampin
• Minocycline
• Penicillin
• Ceftriaxone
• Azithromycin

• The effectiveness of these antibiotics may vary depending on the population and the specific strain of N. meningitidis 3, 4, 5, 6, 7.

Considerations for Nigeria

• The choice of antibiotic for post-exposure prophylaxis in Nigeria should be based on the local epidemiology of N. meningitidis and the availability of antibiotics 3, 4, 5, 6.
• The use of rifampin in outbreak settings may lead to the circulation of resistant isolates, and alternative antibiotics such as ciprofloxacin, ceftriaxone, or azithromycin should be considered 3, 4, 5, 6, 7.