From the Guidelines
Post-exposure prophylaxis for Neisseria meningitidis should be administered as soon as possible, ideally within 24 hours of exposure, with ciprofloxacin 500 mg as a single oral dose for adults, or rifampin 600 mg orally twice daily for 2 days, as recommended by the most recent guidelines 1.
Recommended Regimens
The following regimens are recommended for post-exposure prophylaxis:
- Ciprofloxacin: 500 mg single oral dose for adults, 250 mg for child contacts aged 5-12 years, and 30 mg/kg up to a maximum of 125 mg for child contacts under 5 years 1
- Rifampin: 600 mg twice a day for 2 days for contacts over 12 years, 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 under 1 year 1
Special Considerations
- For pregnant women, ceftriaxone is preferred as an alternative option, given as a single intramuscular dose of 250 mg for adults or 125 mg for children under 15 years 1
- Prophylaxis should be given to close contacts of infected individuals, including household members, daycare contacts, and anyone directly exposed to the patient's oral secretions 1
Monitoring and Follow-up
Contacts should be monitored for symptoms like fever, headache, stiff neck, and rash for at least 10 days after exposure, and seek immediate medical attention if these develop 1
From the FDA Drug Label
Rifampin is indicated for the treatment of asymptomatic carriers of Neisseria meningitidis to eliminate meningococci from the nasopharynx. The post-exposure prophylaxis for Neisseria (N.) meningitis is rifampin (PO), to eliminate meningococci from the nasopharynx in asymptomatic carriers 2.
- Key points:
- Rifampin is used to treat asymptomatic carriers of Neisseria meningitidis.
- The drug should be used only when the risk of meningococcal disease is high.
- Rifampin should not be used indiscriminately to preserve its usefulness in treating asymptomatic meningococcal carriers.
From the Research
Post-Exposure Prophylaxis for Neisseria (N.) meningitis
The following antibiotics have been studied for post-exposure prophylaxis of Neisseria (N.) meningitis:
- Ciprofloxacin: effective at eradicating N. meningitidis one week after treatment, with a relative risk (RR) of 0.04; 95% CI 0.01 to 0.12 3, 4, 5, 6
- Rifampin (rifampicin): effective at eradicating N. meningitidis one week after treatment, with a RR of 0.17; 95% CI 0.12 to 0.24 3, 4, 5, 6
- Minocycline: effective at eradicating N. meningitidis one week after treatment, with a RR of 0.30; 95% CI 0.19 to 0.45 3, 4, 5
- Ampicillin: effective at eradicating N. meningitidis one week after treatment, with a RR of 0.41; 95% CI 0.25 to 0.66 3
- Penicillin: effective at eradicating N. meningitidis one week after treatment, with a RR of 0.47; 95% CI 0.24 to 0.94 5, 6
- Ceftriaxone: more effective than rifampin after one to two weeks of follow-up, with a RR of 5.93; 95% CI 1.22 to 28.68 3, 4, 5, 6
- Azithromycin: has been shown to eradicate meningococcal colonization, and all isolates were susceptible to azithromycin according to the CLSI breakpoint (95% CI 0.0%-1.5%) 7
Effectiveness of Prophylactic Treatment Regimens
The effectiveness of different prophylactic treatment regimens has been studied, including:
- Preventing secondary cases of meningococcal disease after contact with a case
- Preventing cases of meningococcal disease in populations with a high rate of N. meningitidis carriers
- Eradicating N. meningitidis from the pharynx in healthy carriers of N. meningitidis The studies found that prophylactic treatment has been proven to reduce the risk of disease among household contacts, but placebo-controlled trials do not seem ethical 3, 4, 5, 6
Adverse Events and Development of Drug Resistance
Mild adverse events associated with treatment were observed, and the development of drug resistance is a concern, particularly with the use of rifampin during an outbreak, which may lead to the circulation of resistant isolates 3, 4, 5, 6