What is the dose and frequency of doxycycline (tetracycline antibiotic) for treating meningococcal (Neisseria meningitidis) disease?

Doxycycline Dosing for Neisseria Meningitidis Treatment

Doxycycline is not the primary recommended treatment for meningococcal disease (Neisseria meningitidis). The standard treatment regimen for meningococcal disease requires other antibiotics, while doxycycline is primarily used for other conditions such as tickborne rickettsial diseases. 1

Primary Treatment for Meningococcal Disease

First-Line Therapy

• Ceftriaxone is the preferred treatment for meningococcal disease, administered as a single daily intravenous dose of 100 mg/kg on day one, followed by 80 mg/kg daily 2
• Ceftriaxone has been shown to achieve CSF concentrations 10-100 times higher than the minimum inhibitory concentration (MIC) of N. meningitidis 2

Alternative Antibiotics

• Ciprofloxacin has demonstrated effectiveness against N. meningitidis and is used primarily for prophylaxis rather than treatment 3, 4
• Rifampin can be used as an alternative prophylactic agent but has concerns regarding development of resistance 3, 4

Doxycycline Use in Related Conditions

While not the primary treatment for meningococcal disease, doxycycline is used in the following scenarios:

Tickborne Diseases with Meningococcal-Like Presentation

• For adults: 100 mg twice daily (orally or intravenously) 1
• For children weighing <100 lbs (45 kg): 2.2 mg/kg body weight twice daily (orally or intravenously) 1
• Treatment duration: at least 3 days after fever subsides with a minimum treatment course of 5-7 days 1

Adjunctive Therapy Considerations

• Doxycycline has shown anti-inflammatory properties that may reduce brain injury and cochlear damage in experimental models of bacterial meningitis 5
• When meningococcal disease is in the differential diagnosis alongside tickborne rickettsial diseases, appropriate antibiotics for both conditions should be administered while awaiting definitive diagnosis 1

Prophylaxis for Close Contacts

For prophylaxis of close contacts of meningococcal disease patients, the following are recommended:

Ciprofloxacin (First Choice)

• Adults: 500 mg single oral dose 1, 6
• Children 5-12 years: 250 mg single oral dose 1, 6
• Children under 5 years: 30 mg/kg (maximum 125 mg) single oral dose 1, 6

Rifampin (Alternative)

• Adults and children >12 years: 600 mg twice daily for 2 days 1, 6
• Children 1-12 years: 10 mg/kg twice daily for 2 days 1, 6
• Infants <12 months: 5 mg/kg twice daily for 2 days 1, 6

Ceftriaxone (Alternative)

• Adults: 250 mg intramuscular single dose 1, 6
• Children <16 years: 125 mg intramuscular single dose 1, 6

Important Clinical Considerations

• In areas with increasing ciprofloxacin resistance, alternative prophylactic antibiotics should be considered 7
• All cases of meningococcal disease should be reported to public health authorities 1
• Prophylaxis should be initiated for all close contacts, including household members and those directly exposed to oral secretions 1, 6
• Vaccination should be considered for unvaccinated contacts of cases caused by vaccine-preventable serogroups 1

Pitfalls and Caveats

• Delaying appropriate antibiotic treatment for meningococcal disease can lead to increased morbidity and mortality 1
• Doxycycline is not FDA-approved specifically for meningococcal disease treatment 1
• Using rifampin during outbreaks may lead to circulation of resistant isolates 3, 4
• Secondary attack rates are approximately 2-4 per 1000 population in close contacts of cases, representing a 1000-fold increase above the overall attack rate 1