What is the recommended prophylaxis and management following suspected meningitis exposure?

Prophylaxis and Management Following Suspected Meningitis Exposure

For individuals exposed to suspected meningitis, antibiotic prophylaxis should be administered as soon as possible, with ciprofloxacin 500 mg as a single oral dose being the preferred first-line option for adults. 1

Immediate Prophylaxis Recommendations

First-Line Prophylactic Options:

• Ciprofloxacin: 500 mg single oral dose (preferred for adults over 16 years) 1
• Rifampin: 600 mg twice daily for 2 days 1, 2
• Ceftriaxone: 250 mg IM single dose (preferred during pregnancy) 1, 3

Timing of Prophylaxis:

• Administer as soon as possible after exposure, regardless of whether exposure occurred recently or up to 6 days ago 1
• Do not delay prophylaxis while waiting for confirmation of meningococcal disease 4, 1

Isolation and Barrier Precautions

• All patients with suspected meningitis or meningococcal sepsis should be respiratory isolated until meningococcal disease is excluded or they have received 24 hours of ceftriaxone or a single dose of ciprofloxacin 4
• Droplet precautions should be implemented until the patient has received 24 hours of effective antibiotic therapy 4
• Surgical masks should be worn by healthcare workers if likely to be in close contact (<3 feet) with respiratory secretions or droplets 4, 1

Who Should Receive Prophylaxis

Healthcare Workers:

• Prophylaxis is indicated for healthcare workers who have been in close contact with a patient's respiratory secretions or droplets 4
• This primarily includes those involved in airway management without wearing a mask (e.g., during intubation or CPR) 4
• The risk for healthcare workers is estimated to be 25 times greater than the general population, though lower than household contacts 4

Close Contacts:

• Household members and others with direct exposure to the patient's oral secretions 4, 1
• Those who performed mouth-to-mouth resuscitation or unprotected direct suctioning of respiratory secretions 1

Special Considerations

Pregnancy:

• Ceftriaxone (250 mg IM single dose) is the preferred option during pregnancy 1
• Ciprofloxacin is contraindicated in pregnancy 1

High-Risk Individuals:

• For individuals with asplenia, complement deficiencies, or HIV infection, consider meningococcal vaccination in addition to antibiotic prophylaxis 4, 1
• Adults with complement deficiency or on Eculizumab therapy are at increased risk of invasive meningococcal infection and should receive both vaccination and prophylactic antibiotics 4

Post-Exposure Monitoring

• All exposed individuals should be monitored for symptoms of meningococcal disease for at least 10 days after exposure 1
• Early symptoms may include fever, headache, neck stiffness, photophobia, and rash 5, 6
• If symptoms develop, immediate medical attention should be sought as bacterial meningitis is a medical emergency requiring prompt treatment 7, 6

Common Pitfalls and Caveats

• Delaying antibiotic prophylaxis while waiting for laboratory confirmation can increase risk of disease transmission 4, 6
• Not identifying all close contacts who require prophylaxis can lead to secondary cases 4
• Failing to implement appropriate isolation precautions can lead to healthcare-associated transmission 4
• Underestimating the severity of meningococcal disease can lead to delayed treatment and worse outcomes 7, 8

Remember that bacterial meningitis is a medical emergency with high mortality and morbidity despite modern treatments, making proper prophylaxis of exposed individuals critical for preventing secondary cases 5, 6.