Indications for clearance antibiotics for invasive meningococcal or Hib disease

Clearance antibiotics (meningitis prophylaxis or chemoprophylaxis) are recommended for some patients (index cases) and close contacts after an episode of:

• Neisseria meningitidis (meningococcal) meningitis or other invasive meningococcal disease (eg sepsis)
• Haemophilus influenzae type b (Hib) meningitis or other invasive Hib disease (eg epiglottitis).

Invasive meningococcal and invasive Haemophilus influenzae type b (Hib) infection are notifiable diseases in Australia; report all confirmed and probable cases to the local public health authority.

Clearance antibiotics are used to eradicate asymptomatic nasopharyngeal carriage, so that susceptible contacts do not develop invasive infection. A contact may acquire the infection from the index case. Alternatively, they may be an asymptomatic carrier of the organism that caused the initial infection in the index case. Australian public health guidelines for the management of invasive meningococcal disease and invasive Hib infection include definitions of an index case and close contact, and discussion of the role of vaccination. For detailed advice on vaccination, see the Australian Immunisation Handbook.

Discuss the role of clearance antibiotics for contacts of the index case with the local public health authority.

Patients with invasive meningococcal or Hib disease only require clearance antibiotics if they were not treated with ceftriaxone, cefotaxime or a quinolone (eg ciprofloxacin, moxifloxacin), because these drugs clear nasopharyngeal carriage.

For clearance antibiotic regimens, see:

• Clearance antibiotics for invasive meningococcal disease
• Clearance antibiotics for invasive Hib disease.

Disease can occur in contacts despite clearance antibiotics; rarely, disease can recur in the index case. It is essential to provide education to contacts about frequent observation and advise contacts to seek urgent medical attention at the first signs of unexplained illness.