Chemoprophylaxis for Meningococcal Exposure

 

Candidates for chemoprophylaxis:

(1) household contacts

(2) contacts in day care centers

(3) contacts exposed to oral secretions (kissing, sexual partners)

(4) health care providers only with significant exposure to oral secretions such as mouth-to-mouth resuscitation, endotracheal intubation or endotracheal tube management

 

The attack rate in household contacts exposed to persons with sporadic meningococcal disease has been estimated as 4 cases per 1,000 persons exposed (> 500 times risk of general population).

 

The rate of secondary disease for close contacts is highest during the first few days after the onset of disease in the primary patient.

 

Chemoprophylaxis should be administered as soon as possible after identification of primary case:

(1) preferably <= 24 hours after identification of index case

(2) probably of no benefit > 14 days after onset of illness in index case

 

Culturing people prior to chemoprophylaxis is not recommended due to:

(1) delay in starting therapy

(2) prevalence of meningococcal carriage rate in general population

 

If the index patient is treated with an antibiotic not known to elimination nasopharyngeal colonization, then s/he should receive one of the following regimens before discharge from the hospital.

 

Elimination of Asymptomatic Nasopharyngeal Colonization

 

Rifampin

(1) dosage regimens: every 12 hours for 2 days (4 doses)

(1a) children < 1 month: 5 mg/kg

(1b) children >= 1 month: 10 mg/kg up to 600 mg

(1c) adults >= 18 years of age: 600 mg

(2) not recommended for pregnant women

(3) rifampin can color urine and body fluids a reddish-orange and may permanently discolor soft contact lenses

(4) may reduce effectiveness of oral contraceptives

(5) lack of compliance with full regimen may result in prophylaxis failure

 

Ciprofloxacin

(1) single 500 mg dose po

(2) not recommended:

(2a) for pregnant and lactating women

(2b) not recommended in those < 18 years of age, but may be used if no other alternative for chemoprophylaxis is available

 

Azithromycin

(1) single 500 mg dose po

 

Ceftriaxone or third generation cephalosporins

(1) dosage regimen of ceftriaxone: single IM dose

(1a) children < 15 years: 125 mg

(1b) adults: 250 mg

(2) may be diluted with 1% lidocaine to reduce pain at injection site

(3) not recommended for persons with allergy to beta-lactam antibiotics