Recommended Antibiotics for Prophylaxis in Close Contacts of Neisseria meningitidis Meningitis
The two antibiotics most strongly recommended for prophylaxis in close contacts of patients with Neisseria meningitidis meningitis are rifampin and ciprofloxacin. 1, 2
First-Line Prophylactic Options
Rifampin
- Recommended as 600 mg orally twice daily for 2 days in adults 2, 3
- Effective at eradicating nasopharyngeal carriage of N. meningitidis 1, 4
- FDA-approved specifically for treatment of asymptomatic carriers of N. meningitidis to eliminate meningococci from the nasopharynx 3
Ciprofloxacin
- Recommended as a single 500 mg oral dose for adults 2
- Preferred in the UK guidelines due to single-dose convenience and availability 1
- Highly effective with eradication rates of 90-95% 1, 4
Alternative Option
Ceftriaxone
- Recommended as a single 250 mg intramuscular dose for adults 1, 2
- Particularly useful when compliance with multi-day regimens is a concern 1
- Effective alternative when rifampin or ciprofloxacin cannot be used 4
Emerging Alternative
Azithromycin
- A single 500 mg oral dose has been shown to be effective in eradicating nasopharyngeal carriage 1, 5
- May be considered as an alternative, though requires further evaluation 1
- No resistant isolates found in a German study of invasive meningococcal strains 5
Important Considerations
- Prophylaxis should be administered as soon as possible, ideally within 24 hours after identification of the index patient 1
- Prophylaxis administered >14 days after onset of illness in the index patient has limited or no value 1
- Close contacts include household members, child care center contacts, and anyone directly exposed to the patient's oral secretions 1, 2
- The risk of meningococcal disease is increased 400-800 fold in close contacts of patients 1, 2
Special Considerations for Antibiotic Selection
- In areas with documented ciprofloxacin resistance, alternative agents should be used 6, 7
- Resistance patterns should be monitored, as resistant strains have been reported globally 6, 8
- Patients treated with penicillin should receive clearance-effective antibiotics before discharge; those treated with ceftriaxone do not need additional prophylaxis 1
Pitfalls to Avoid
- Nasopharyngeal cultures are not helpful in determining the need for prophylaxis and might unnecessarily delay preventive measures 1
- Delaying prophylaxis beyond 24 hours reduces effectiveness, as the rate of secondary disease is highest immediately after onset in the index patient 1
- Using rifampin during an outbreak may lead to circulation of resistant isolates 4
- Ciprofloxacin should not be used in areas with documented resistance 6, 7