HWN Suggests

Meningitis Chemoprophylaxis

There are a lot of rewarding parts of our jobs… getting to play pat-a-cake with a toddler is certainly one of them… but I was recently reminded of a potential downside: placing yourself in harm’s way. Do not construe that our job has similar inherent physical hazards that firefighters face during the course of what they call “work,” but we do routinely encounter potential hazards. For instance, that LP you just performed had purulent fluid drain into the tubes… the nurse and family immediately become concerned for themselves… should you too. What “bystanders” need therapy too? Here’s what I have deduced regarding Meningitis Chemoprophylaxis:

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Featured

 Updated Recommendations for Invasive Meningococcal Disease (IMD) Post-Exposure Prophylaxis (PEP)

In May 2023, CDC issued public health guidance and recommended to discontinue use of ciprofloxacin post-exposure prophylaxis (PEP) in close contacts exposed to IMD cases in any geographic area where over a rolling 12-month period, two or more IMD cases caused by ciprofloxacin-resistant strains are reported, and cases caused by ciprofloxacin-resistant strains make up at least 20% of all reported IMD cases

Articles of Interest

CDC issues new antibiotic prophylaxis guidelines for invasive meningococcal disease contacts

Under the new guidelines, the CDC recommends other antibiotics be considered if, over a rolling 12-month period, two or more invasive meningococcal disease cases caused by ciprofloxacin-resistant strains are reported in a local catchment area and 20% or more of the invasive meningococcal disease cases in that area are caused by ciprofloxacin-resistant strains. Other recommended options for prophylaxis include rifampin, ceftriaxone, and azithromycin. The CDC says local health departments have flexibility in guidance implementation.

Antibiotics for preventing meningococcal infections

Data from 24 studies, most of high quality, including 6885 participants found that rifampin (also known as rifampicin), ciprofloxacin, ceftriaxone and penicillin are effective agents for eradicating carriage of N meningitidis. However, the use of rifampin may have a disadvantage as development of resistance to the antibiotic has been noted following treatment. Mild adverse events are associated with the different antibiotics used.

Template:Neisseria meningitis post exposure prophylaxis

Indications - Household contacts. School or day care contacts in previous 7 days. Direct exposure to patient's secretions (kissing, shared utensils or toothbrush). Intubation without facemark.

What Constitutes Exposure?

Healthcare personnel (HCP) may become exposed by having direct, close contact with mucous membranes or secretions from a patient who has documented meningococcal disease (e.g., such as by providing mouth-to-mouth resuscitation or inserting or manipulating an endotracheal tube while not wearing appropriate personal protective equipment). Lesser contact with an infected patient (e.g., being in the same room, same hallway, or having encounters other than face-to-face, delivering meals, or even performing a history and physical) is not classified as an exposure. Additionally, having unprotected direct contact with respiratory secretions or saliva of a person who is colonized with N. meningitidis, but who does not have clinical disease, also is not considered an exposure.

Resources

Life in the Fastlane

Prophylaxis needed for close contacts if <24h treatment with appropriate antibiotics: ciprofloxacin 500 mg (child younger than 5 years: 30 mg/kg up to 125 mg; child 5 to 12 years: 250 mg) orally, as a single dose, OR ceftriaxone 250 mg (child 1 month or older: 125 mg) IM, as a single dose (preferred option for pregnant women), OR rifampicin 600 mg (neonate: 5 mg/kg; child: 10 mg/kg up to 600 mg) orally, 12-hourly for 2 days. (NB. interacts significantly with many drugs (eg with the oral contraceptive pill) and is contraindicated in pregnancy and severe liver disease.)

UMEM

Chemoprophylaxis should be given to those individuals who came into "close contact" with someone infected with meningitis due to meningococcal infection (i.e. Neisseria meningitidis). It should be given as early as possible following the exposure; when there is a high index of suspicion, do not wait for culture results to give prophylaxis. While the definition of a "close contact" remains somewhat ambiguous, it generally refers to individuals who have had prolonged (>8 hours) contact while in close proximity (<3 ft) to the patient, or who have been directly exposed to the patient's oral secretions between one week prior to the onset of the patient's symptoms until 24 hours after initiation of appropriate antibiotic therapy.