Prophylaxis

Preventative measures for bacterial meningitis include:

• prophylactic antibiotics, for example, rifampicin for Haemophilus infections and N. meningitidis. This is recommended for close, usually household, contacts of patients with meningococcal infection, but only for families and other close contacts with children under 4 years of age in the case of Haemophilus infection. Pregnant women should not be given rifampicin prophylaxis. It is also recommended that there is prophylaxis for patients themselves.
• drugs recommended for use in preventing secondary cases of meningococcal disease include (1):
  • rifampicin
    • the only antibacterial agent licensed for use as chemoprophylaxis.
    • can be used in all age groups
  • ciprofloxacin
    • can be used as an alternative to rifampicin for chemoprophylaxis
    • can be used in adults and children above the age of two
    • can be given as a single dose
  • ceftriaxone
    • can only be given as an injection
• vaccine - Hib, meningococcal Group C vaccine, S.pneumonia - for high risk patients

Notes:

• ciprofloxacin as prophylaxis (1)
  • ciprofloxacin is recommended when large numbers of contacts (aged 2 years or above) need prophylaxis. Ciprofloxacin has a number of advantages over rifampicin. It is given as a single dose (500 mg in adults and children over 12 years, 250 mg for children aged 5-12 years, 125mg for children 2-4yrs), it does not interact with oral contraceptives, and it is more readily available in community pharmacies
    • may, however, be followed by anaphylactic reactions. Healthcare staff should give out information sheets that include the risk of side effects, and be prepared to deal with allergic reactions. It can also interact with other drugs but a single dose is unlikely to have a significant effect. It has an unpredictable effect on epilepsy but may be preferable to rifampicin if on treatment with phenytoin
    • manufacturers do not recommend using ciprofloxacin in children or growing adolescents unless benefits of treatment are considered to outweigh risks. Concern has been raised about the possibility of joint/cartilage damage seen in immature animals given ciprofloxacin. Such effects have not been observed in children despite extensive use. Ciprofloxacin suspension is currently licensed for other indications in children above 2 years of age

Reference:

• (1) Guidance for public health management of meningococcal disease in the UK.Health Protection Agency Meningococcus Forum.2006.