What is the prophylaxis for close contacts of a patient diagnosed with meningitis, specifically caused by Neisseria meningitidis?

Prophylaxis for Contacts of Meningococcal Meningitis Patients

Ciprofloxacin is the preferred first-line prophylactic antibiotic for close contacts of patients with meningococcal meningitis, given as a single oral dose of 500 mg for adults. 1 However, rifampicin and ceftriaxone are also effective alternatives when ciprofloxacin cannot be used.

Recommended Prophylactic Regimens

First-line option:

• Ciprofloxacin:
  • Adults: 500 mg orally as a single dose
  • Children 5-12 years: 250 mg orally as a single dose
  • Children under 5 years: 30 mg/kg orally as a single dose 1
  • Advantages: Single dose, readily available in pharmacies, 90-95% efficacy in reducing nasopharyngeal carriage 2, 1
  • Not recommended during pregnancy 2

Alternative options:

• Rifampicin:

  • Adults: 600 mg orally twice daily for 2 days
  • Children >12 years: 600 mg orally twice daily for 2 days
  • Children 3 months-12 years: 10 mg/kg twice daily for 2 days (max 600 mg)
  • Children <3 months: 5 mg/kg twice daily for 2 days 2, 1
  • Can be used after first trimester of pregnancy: 600 mg twice daily for 2 days 2

• Ceftriaxone:

  • Adults: 250 mg intramuscular as a single dose
  • Children <16 years: 125 mg intramuscular as a single dose 2, 1
  • First choice during pregnancy: 250 mg intramuscular as a single dose 2

Who Should Receive Prophylaxis?

Prophylaxis should be given to:

• Household members of the patient 2, 1
• Child care center contacts 2, 1
• Anyone directly exposed to the patient's oral secretions (e.g., kissing, mouth-to-mouth resuscitation) 2, 1
• Healthcare workers who handled the patient's airways or were exposed to respiratory secretions 1
• Passengers seated directly next to the patient on long flights (≥8 hours) 1

Timing of Prophylaxis

• Prophylaxis should be administered as soon as possible, ideally within 24 hours after identification of the index case 1
• Prophylaxis has no value when administered after 14 days of exposure 1
• Do not delay prophylaxis for nasopharyngeal cultures, as they are not useful in determining the need for prophylaxis 1

Important Considerations

1. Resistance concerns: Recent data indicates increasing ciprofloxacin resistance in some areas. In regions where there have been two or more cases of ciprofloxacin-resistant meningococcal disease in a 12-month period AND ≥20% of cases are caused by resistant strains, alternative antibiotics should be considered 3.

2. Index patient prophylaxis: Patients who received treatment with antibiotics other than ceftriaxone or other third-generation cephalosporins should receive prophylactic antibiotics before hospital discharge to eradicate nasopharyngeal carriage 1.

3. Vaccination: Unimmunized contacts of cases caused by vaccine-preventable serogroups should receive appropriate meningococcal vaccination 1.

4. Monitoring period: The general practice records of all close contacts should be labeled to alert doctors that an increased risk of meningococcal disease persists for 6 months 2.

5. Special case - H. influenzae meningitis: For contacts of H. influenzae type B meningitis, rifampicin (20 mg/kg once daily, max 600 mg, for 4 days) is recommended for household contacts where there is an at-risk individual (child under 10 or immunosuppressed person) 2.

6. Pneumococcal meningitis: Close contacts of pneumococcal meningitis are not usually at increased risk and do not require antibiotic prophylaxis 2.

By implementing prompt and appropriate prophylaxis, the risk of secondary cases of meningococcal disease can be significantly reduced, as the attack rate for household contacts is estimated to be 500-800 times higher than for the general population 1.