From the Guidelines
For meningococcemia prophylaxis among close contacts, the recommended dose is ciprofloxacin 500 mg stat for adult contacts, 250 mg stat for child contacts aged 5-12 years, and 30 mg/kg up to a maximum of 125 mg stat for child contacts under 5 years, as per the most recent and highest quality study 1. The choice of antibiotic is crucial in preventing secondary cases of meningococcal disease among close contacts.
- Ciprofloxacin is the preferred agent due to its ease of administration and high efficacy in eradicating nasopharyngeal carriage of Neisseria meningitidis.
- Alternative regimens, such as rifampicin, can be used in cases where ciprofloxacin is contraindicated or not tolerated, with dosages of 600 mg twice a day for 2 days for contacts over 12 years, 10 mg/kg twice a day for 2 days for contacts aged 1-12 years, and 5 mg/kg twice a day for 2 days for contacts under 1 year 1. Prophylaxis should be administered as soon as possible, ideally within 24 hours of identifying the index case, to maximize its effectiveness in preventing secondary cases.
- Close contacts requiring prophylaxis include household members, daycare contacts, anyone directly exposed to the patient's oral secretions, and healthcare workers who performed mouth-to-mouth resuscitation or intubation. The use of prophylactic antibiotics has been shown to decrease carriage and secondary cases of meningococcal disease, with ceftriaxone, rifampicin, and ciprofloxacin being the most effective agents 1.
- It is essential to note that pregnant women should receive ceftriaxone as it is considered safer during pregnancy than the other options, although this is not the first-line agent for non-pregnant individuals 1.
From the Research
Meningococcemia Prophylaxis among Close Contacts
- The dose for meningococcemia prophylaxis among close contacts is not explicitly stated in the provided studies, but the effectiveness of different antibiotics in eradicating Neisseria meningitidis is discussed 2, 3, 4, 5.
- Ciprofloxacin, rifampin, minocycline, and penicillin have been shown to be effective in eradicating N. meningitidis one week after treatment, with rifampin, ciprofloxacin, and penicillin still effective at one to two weeks 2, 3, 4, 5.
- Ceftriaxone has been compared to rifampicin in one study, which found that ceftriaxone was significantly more effective in eradicating pharyngeal carriage of group A Neisseria meningitidis, with eradication rates of 97% at both 1 and 2 weeks, compared to 75% and 81% for rifampicin, respectively 6.
- The use of rifampin during an outbreak may lead to the circulation of resistant isolates, and the use of ciprofloxacin, ceftriaxone, or penicillin should be considered 2, 3, 4, 5.
- Mild adverse events associated with treatment have been observed, but no serious side-effects were associated with either ceftriaxone or rifampicin in the study comparing the two 6.