1.

Describe how nasopharyngeal eradication is performed and its significance wrt to

meningococcal infection

Provide Antibiotic Prophylaxis for Close Contacts

The purpose of chemoprophylaxis is to eradicate nasopharyngeal colonization by N. meningitidis
and thus prevent disease in contacts and transmission to susceptible persons. In addition, levels
of chemotherapeutic agents in nasal secretions may prevent acquisition of the organism for a few
days. Chemoprophylaxis is not effective in preventing disease once invasion of tissue has taken
place.
The means by which chemoprophylaxis prevents secondary disease is by preventing
transmission of the bacteria to susceptible hosts and by eradicating the organism from the
nasopharynx of those who are already colonized. Such therapy is recommended for close
contacts of patients infected with H influenzae or N meningitidis. In general, close contacts are
defined as household or day-care members who sleep or eat in the same dwelling as the index
patient. Therefore, health care workers do not require chemoprophylaxis unless close contact
with the patient's secretions occurs, as in mouth-to-mouth resuscitation.

Since penicillin, ampicillin, and chloramphenicol do not reliably eradicate nasopharyngeal

colonization with H influenzae or N meningitidis, index patients who are treated with one of
these agents should subsequently receive one of the above chemotherapeutic regimens
(Ciprofloxacin or Rifampin)

Chemoprophylaxis for Close Contacts

Drug Dosage Comments
Ciprofloxacin Adults >= 18 Contraindicated during
years of age: pregnancy and lactation.
500 mg x 1 dose
PO Only approved for persons >
18 years of age. Not
recommended for prepubertal
children.
Rifampin Adults: Contraindicated in pregnancy.
600 mg PO q12h x
4 doses Urine and tears may be stained
red. Advise against wear of soft
Children >= 1 contact lenses as they can also
month of age: be stained.
10mg/kg
(maximum 600 Can reduce effectiveness of
mg) per dose PO oral contraceptives. Advise use
q12h x 4 doses of alternative contraceptive
measures.
Infants < 1
 month of age:
5mg/kg per dose
PO q12h x 4 doses
Ceftriaxone Adults: Recommended drug for
250 mg IM x 1 pregnant women.
dose
Alternative for persons who
Children <12 cannot tolerate oral
years: medication.
125 mg IM x 1
dose Dilute in 1% lidocaine to
reduce pain at injection site.