Cases of Neisseria meningitidis have been reported among Orange County residents recently.
REMINDER: Due to the detection of ciprofloxacin-resistant strains of Neisseria meningitidis nationally, including in Southern California, public health and medical providers in California are recommended to discontinue the use of ciprofloxacin for invasive meningococcal disease (IMD) post-exposure prophylaxis (PEP).
Rifampin, ceftriaxone or azithromycin are recommended options for IMD PEP in California.
No changes to empiric treatment of IMD are recommended at this time.
Provider Recommendations and Resources
Close contacts of persons with meningococcal disease should receive antimicrobial chemoprophylaxis, regardless of immunization status, due to increased risk for infection. Close contacts include: 1) household members, 2) childcare center contacts, and 3) anyone else directly exposed to an infected patient’s oral secretions (e.g., via kissing, mouth-to-mouth resuscitation, endotracheal intubation or endotracheal tube management) in the 7 days before symptom onset.
Ciprofloxacin should no longer be used for chemoprophylaxis for close contacts of persons with invasive meningococcal disease.
The following is the currently recommended chemoprophylaxis regimes for close contacts of persons with invasive meningococcal disease for Orange County:
Drug
Age
Dose
Duration
Comments
Azithromycin
10 mg/kg (maximum 500 mg)
Single dose
Equivalent to rifampin for eradication of N. meningitidis from nasopharynx in one study
Ceftriaxone
<15 years
125 mg, intramuscular
Single dose
To decrease pain at injection site, dilute with 1% lidocaine.
≥15 years
250 mg, intramuscular
Single dose
Rifampin
<1 month
5 mg/kg, orally, every 12 hours
2 days
Discussion with an expert for infants <1 month
≥1 month
10 mg/kg (maximum 600 mg), orally, every 12 hours
2 days
Can interfere with efficacy of oral contraceptives and some seizure prevention and anticoagulant medications; may stain soft contact lenses. Not recommended for pregnant women.
While antibiotic sensitive testing (AST) on Neisseria meningitidis is not commonly performed in hospital laboratories, microbiologists are encouraged to contact their preferred reference laboratory about conducting AST testing on isolates Neisseria meningitidis from invasive sites.
