Threshold for Changing Meningococcal Disease Prophylaxis Antibiotics in Areas with Ciprofloxacin Resistance
Antibiotic prophylaxis with ciprofloxacin in areas with ciprofloxacin resistance can result in prophylaxis failure. This guidance is intended to help health departments make decisions about when and where recommended antibiotic prophylaxis options other than ciprofloxacin should be preferentially considered. This pertains to prophylaxis of close contacts1 of patients with invasive meningococcal disease in their jurisdictions.
Antibiotic prophylaxis is recommended for close contacts
Meningococcal disease is a rare but life-threatening illness requiring prompt antibiotic treatment for patients and antibiotic prophylaxis for their close contacts. First-line choices for antibiotic prophylaxis include:
Azithromycin may also be used in areas with ciprofloxacin-resistant strains.
Antibiotic resistance is increasing
Historically, resistance to the antibiotics used for meningococcal treatment and prophylaxis has been uncommon in the United States. However, the number of cases caused by ciprofloxacin-resistant strains has increased. In some local areas, these cases account for over half of all reported meningococcal disease cases.
- Discontinue use of ciprofloxacin for prophylaxis of close contacts when both of the following threshold criteria have been met in the catchment area2 during a rolling 12-month period:
- ≥2 invasive meningococcal disease cases caused by ciprofloxacin-resistant strains have been reported, and
- Cases caused by ciprofloxacin-resistant strains account for ≥20% of all reported invasive meningococcal disease cases.
- Prescribe rifampin, ceftriaxone, or azithromycin instead of ciprofloxacin as prophylaxis when the threshold criteria have been reached.3
- Implement updated prophylaxis guidance in all counties within the catchment area.
- Maintain updated prophylaxis guidance until a full 24 months have passed without any invasive meningococcal disease cases caused by ciprofloxacin-resistant strains having been reported in the catchment area.
Health departments have flexibility in guidance implementation
Updated prophylaxis guidance can be implemented at a lower threshold or extended across a broader area.4 Other health department considerations in determining guidance implementation include:
- Local epidemiology
- Feasibility (e.g., logistical simplicity of having a particular geographic area follow uniform guidance)
- Epidemiologic linkages among patients
- Travel history, including travel to/from school for college and other students5
- Patterns in population movement, including movement across jurisdictional borders
Notify CDC about any local changes made to prophylaxis guidance. CDC is also available to consult if questions arise. For questions or reporting prophylaxis changes, please contact the CDC meningitis team at firstname.lastname@example.org.
1 Close contacts include household members, childcare center contacts, and anyone else directly exposed to an infected patient’s oral secretions in the 7 days before symptom onset. Potential oral secretion exposures include kissing, mouth-to-mouth resuscitation, and endotracheal intubation or endotracheal tube management. This definition is taken from the Manual for the Surveillance of Vaccine-Preventable Diseases.
2 The catchment area should be a single contiguous area that contains all counties reporting ciprofloxacin-resistant cases. Jurisdictions should include surrounding counties, if warranted, based on population mixing patterns.
3 Additional information regarding recommended prophylaxis regimens is available in the Manual for the Surveillance of Vaccine-Preventable Diseases.
5 Additional information regarding guidelines for determining residency for disease reporting is available from the Council of State and Territorial Epidemiologists.