Clearance antibiotics for invasive meningococcal disease

After an episode of Neisseria meningitidis (meningococcal) meningitis or other invasive meningococcal disease (eg sepsis), clearance antibiotics are recommended for some patients (index cases) and close contacts. Discuss the role of clearance antibiotics for close contacts with the local public health authority. For definitions of an index case and close contacts, see the Australian public health guidelines for the management of invasive meningococcal disease.

Suitable regimens for clearance of N. meningitidis areCommunicable Diseases Network Australia (CDNA) 2017:

1ciprofloxacin orally, as a single dose1 ciprofloxacin ciprofloxacin ciprofloxacin

adult, or child 12 years or older: 500 mg. For dosage adjustment in adults with kidney impairment, see ciprofloxacin oral dosage adjustment

child younger than 5 years: 30 mg/kg up to 125 mg2

child 5 to 12 years: 250 mg2

OR

1ceftriaxone intramuscularly, as a single dose ceftriaxone ceftriaxone ceftriaxone

adult, or child 12 years or older: 250 mg

child 1 month to younger than 12 years: 125 mg

OR

1rifampicin orally, 12-hourly for 2 days rifampicin rifampicin rifampicin

adult: 600 mg. For dosage adjustment in adults with kidney impairment, see rifampicin dosage adjustment

neonate: 5 mg/kg

child 1 month or older: 10 mg/kg up to 600 mg.

Ceftriaxone is preferred in pregnant people. Rifampicin is preferred in neonates. Rifampicin is contraindicated in pregnancy and severe liver disease.

1 An oral liquid formulation of ciprofloxacin is not commercially available; for formulation options for children or people with swallowing difficulties, see Don’t Rush to Crush, which is available for purchase from the Advanced Pharmacy Australia website or through a subscription to eMIMSplus.Return
2 Ciprofloxacin is not licensed for use in children on the basis of animal studies that showed an adverse effect on cartilage development with quinolone use; however, clinical trial data suggest that adverse musculoskeletal events are usually mild and short term, similar to those observed in adults. Ciprofloxacin can be used in children when it is the drug of choice.Return