Describe How Nasopharyngeal Eradication Is Performed And Its Significance Wrt To Meningococcal Infection.docx

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

Ciprofloxacin Adults >= 18 years of age:

Comments Contraindicated during 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.