Meningococcal Disease: New Guidance on Prophylaxis for Close Contacts

Meningococcal Disease: New Guidance on Prophylaxis for Close Contacts

In recent years, the rise of ciprofloxacin-resistant cases of meningococcal disease has posed a significant challenge in the United States. The Centers for Disease Control and Prevention (CDC) has now released new guidance regarding the prophylaxis of close contacts of individuals with meningococcal disease in areas where ciprofloxacin resistance is highly prevalent. This article will explore the updated recommendations and discuss the use of alternative antibiotics for prophylaxis.

The CDC advises health departments to consider alternative antibiotics for prophylaxis in areas where there have been two or more invasive meningococcal disease cases caused by ciprofloxacin-resistant strains within the local catchment area. Additionally, if 20% or more of all reported invasive meningococcal disease cases in that area are caused by ciprofloxacin-resistant strains, other antibiotics should be used for prophylaxis. The recommended alternatives to ciprofloxacin include rifampin, ceftriaxone, and azithromycin.

According to the CDC, the updated prophylaxis approach should be maintained until a full 24 months have passed without any reported invasive meningococcal disease cases due to ciprofloxacin-resistant strains in the catchment area. It is essential to monitor the effectiveness of the alternative antibiotics during this period to ensure successful prophylaxis.

Ciprofloxacin has traditionally been effective in treating meningococcal disease. However, in recent years, there has been a concerning increase in ciprofloxacin-resistant cases. Between 2011 and 2018, the annual average of invasive meningococcal disease cases caused by ciprofloxacin-resistant strains was 1.25. Disturbingly, from 2019 to 2021, that number rose to an average of 9.7 cases per year, despite a significant decline in the overall incidence of the disease during the same period.

The ciprofloxacin-resistant cases of meningococcal disease have been reported throughout the United States, with clusters observed in specific regions such as New Mexico and California. This geographical distribution highlights the need for nationwide attention to combat the spread of resistant strains.

The CDC plays a crucial role in monitoring and reporting on antimicrobial susceptibility testing for Neisseria meningitidis, the causative agent of invasive meningococcal disease. While local health departments usually do not conduct susceptibility testing, the availability of such information can guide the adjustment of prophylaxis regardless of the CDC’s recommended thresholds.

The CDC based its recommendations for alternative antibiotics on a 2013 systematic review and meta-analysis. Rifampin, as demonstrated in the meta-analysis, was found to be effective in eradicating N. meningitidis a week after prophylaxis. Studies comparing rifampin with ceftriaxone and azithromycin did not show a statistically significant difference in eradication rates. These findings support the use of rifampin, ceftriaxone, or azithromycin as first-line alternatives to ciprofloxacin for prophylaxis.

Ongoing monitoring for antibiotic resistance of meningococcal isolates, along with reporting of prophylaxis failures by healthcare providers, will help guide future updates to prophylaxis considerations and recommendations. With the continuous evolution of antibiotic resistance, it is crucial to remain vigilant and adapt strategies to effectively prevent the spread of meningococcal disease.

The rising prevalence of ciprofloxacin-resistant strains of meningococcal disease necessitates updated guidance for prophylaxis. The CDC recommends alternative antibiotics such as rifampin, ceftriaxone, or azithromycin for close contacts in areas with high ciprofloxacin resistance. Health departments should closely monitor the effectiveness of these antibiotics and adjust prophylaxis accordingly. By staying informed and proactive, healthcare professionals can combat the challenge of antibiotic resistance and protect individuals at risk of meningococcal disease.


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