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Chemoprophylaxis regimens for protection against meningococcal disease after an exposure[1-4]

Chemoprophylaxis regimens for protection against meningococcal disease after an exposure[1-4]
Drug Age group Dose Duration and route of administration Comments
Preferred regimens
Rifampin Infants age <1 month 5 mg/kg/dose every 12 hours 2 days (4 doses) of oral therapy
  • Rifampin is associated with significant drug interactions (eg, oral contraceptives, certain anticoagulants)*.
Infants and children age ≥1 month 10 mg/kg/dose (maximum: 600 mg) every 12 hours 2 days (4 doses) of oral therapy
Adults 600 mg every 12 hours 2 days (4 doses) of oral therapy
Ciprofloxacin Infants and children age ≥1 month 20 mg/kg (maximum 500 mg)Δ Single oral dose
  • In the United States, the CDC states that an alternative agent should be used if two or more ciprofloxacin-resistant meningococcal disease cases that account for ≥20% of all cases are reported in a local catchment area during a 12-month period.
  • Ciprofloxacin should be avoided during pregnancy.
Adults 500 mg Single oral dose
Ceftriaxone Children age <15 years 125 mg Single IM dose
  • Preferred agent in pregnancy.
Adults and adolescents age ≥15 years 250 mg Single IM dose
Alternative regimen (eg, if rifampin or ceftriaxone cannot be used in the setting of ciprofloxacin-resistant Neisseria meningitidis exposure)
Azithromycin Infants and children 10 mg/kg (maximum 500 mg) Single oral dose
  • Although azithromycin has activity against meningococcus, it has not been well studied for this indication.
Adults 500 mg Single oral dose

IM: intramuscular.

* For additional information on drug interactions, refer to the drug interaction program within UpToDate.

¶ The decision to use rifampin during pregnancy must be determined on a case-by-case basis. CDC guidelines state that rifampin should be avoided for chemoprophylaxis in pregnancy. The drug is teratogenic in laboratory animals, and there have been rare reports of postnatal hemorrhages in the infant and mother when administered during the last few weeks of pregnancy. However, rifampin is routinely used for treatment of other infections during pregnancy (eg, tuberculosis).

Δ Although systemic fluoroquinolones are not routinely used as a first-line agent in children less than 18 years of age, it is reasonable to use a single dose of ciprofloxacin for chemoprophylaxis for meningococcal disease.
References:
  1. Cohn AC, MacNeil JR, Clark TA, et al. Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep 2013; 62:1.
  2. American Academy of Pediatrics. Meningococcal infections. In: Red Book: 2021–2024 Report of the Committee on Infectious Diseases, Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH (Eds), American Academy of Pediatrics 2021.
  3. McNamara LA, Blain A. Chapter 8: Meningococcal disease. In: Manual for the Surveillance of Vaccine-Preventable Diseases, Roush SW, Baldy LM, Hall MAK (Eds), Centers for Disease Control and Prevention. Available at: https://www.cdc.gov/vaccines/pubs/surv-manual/chpt08-mening.html (Accessed on August 3, 2022).
  4. Berry I, Rubis AB, Howie RL, et al. Selection of antibiotics as prophylaxis for close contacts of patients with meningococcal disease in areas with ciprofloxacin resistance — United States, 2024. MMWR Morb Mortal Wkly Rep 2024; 73:99.
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