Review Question - QID 202747

Ciprofloxacin would be appropriate prophylaxis following N. meningitidis exposure in this patient.

Chemoprophylaxis is indicated in patients who have had close contact with meningococcal infection, such as a daycare worker caring for a child with meningococcal meningitis. Healthcare workers do not need chemoprophylaxis unless they have had direct exposure to respiratory secretions. Rifampin is the preferred agent, but ciprofloxacin is preferred in patients who cannot tolerate rifampin. The risk of CYP450 induction by rifampin and subsequent unpredictable decreases in this patient's warfarin level (which is metabolized by P450) would prompt the use of ciprofloxacin.

Kimmel reviews the prevention of meningococcal disease. He notes that invasive meningococcal disease has an incidence of about 1 in 100,000 in the United States. Antibiotic prophylaxis is required for household and other close contacts. In addition to rifampin and ciprofloxacin, single dose ceftriaxone has also been used and effective.

McIntyre et al. review the effectiveness of meningitis vaccines, both against N. meningitidis and other causes of meningitis such as S. pneumoniae and H. influenzae. They report that over 90% reduction in disease attributable to vaccine serotypes has been achieved.

Illustration A depicts the symptoms of meningitis.
Illustration B shows the various P450 inducers.

Incorrect Answers:
Answer 2: Rifampin is the classic prophylactic agent for N. meningitidis, but ciprofloxacin is preferred in this patient to avoid CYP450 interactions.
Answer 3: TMP-SMX is the preferred prophylactic agent against P. jiroveci (PCP pneumonia).
Answer 4: Azithromycin and rifabutin are the preferred prophylactic agents against M. avium complex.
Answer 5: Penicillin is the preferred prophylactic agent against T. pallidum, the spirochete that causes syphilis.