What is the prophylactic treatment for exposure to bacterial meningitis?

Prophylactic Treatment for Exposure to Bacterial Meningitis

For close contacts of meningococcal meningitis patients, antibiotic prophylaxis with ceftriaxone, ciprofloxacin, or rifampin should be administered to prevent secondary cases and eradicate nasopharyngeal carriage. 1

Recommended Prophylactic Antibiotics

For Adults:

• Ciprofloxacin: 500 mg oral single dose (adults >16 years) 1, 2
• Rifampin: 600 mg orally twice daily for 2 days 1, 3
• Ceftriaxone: 250 mg intramuscular single dose 1

For Children:

• Rifampin:
  • <3 months: 5 mg/kg twice daily orally for 2 days 1
  • 3 months to 12 years: 10 mg/kg twice daily orally (max 600 mg) for 2 days 1

  • 12 years: 600 mg twice daily orally for 2 days 1

• Ceftriaxone: 125 mg intramuscular single dose (children <16 years) 1

For Pregnant Women:

• Ceftriaxone: 250 mg intramuscular single dose (first choice during pregnancy) 1, 4
• Rifampin: 600 mg twice daily for 2 days (only after first 3 months of pregnancy) 1, 4
• Ciprofloxacin is contraindicated during pregnancy 1, 4

Who Should Receive Prophylaxis

Prophylaxis should be administered to the following individuals exposed to meningococcal meningitis 1:

• Household members 1
• Child care center contacts 1
• Anyone directly exposed to oral secretions of the patient 1, 2
• Laboratory personnel exposed to potentially aerosolized Neisseria meningitidis 2

Timing of Prophylaxis

• Prophylaxis should be administered as soon as possible after exposure is identified 4, 2
• Prophylaxis remains effective even if administered up to 6 days after exposure 2

Effectiveness of Prophylactic Treatment

• Prophylactic antibiotic treatment has been proven effective in preventing secondary cases and eradicating meningococcal carriage 1, 5
• The risk of meningococcal disease is increased 400-800 fold in close contacts of patients with meningococcal disease 1
• A Cochrane meta-analysis of 24 RCTs found ceftriaxone, rifampin, and ciprofloxacin to be the most effective prophylactic antibiotics 1, 5

Special Considerations

• In areas with known ciprofloxacin resistance, alternative antibiotics (rifampin, ceftriaxone, or azithromycin) should be considered 6
• Droplet precautions should be implemented for exposed individuals until they have received 24 hours of effective antibiotic prophylaxis 2
• Monitoring for symptoms of meningococcal disease should continue for at least 10 days after exposure, even after receiving prophylaxis 2

Vaccination Recommendations

• Vaccination with pneumococcal vaccine is recommended after an episode of pneumococcal meningitis 1
• Vaccination is beneficial in patients with CSF leakage to reduce recurrences 1
• Additional vaccination with H. influenzae type b and N. meningitidis vaccines can be considered in patients with CSF leakage 1

Emerging Evidence

• Recent studies have shown that village-wide distribution of ciprofloxacin during outbreaks in the African meningitis belt can reduce overall attack rates 7
• Ongoing monitoring for antibiotic resistance is essential, as resistant strains can emerge, particularly with rifampin use 5, 6