With the number of invasive meningococcal disease cases caused by ciprofloxacin-resistant strains of Neisseria meningitidis rising, the Centers for Disease Control (CDC) yesterday published new guidelines for when other antibiotic prophylaxis (prevention) options should be considered for close contacts of patients.
Published in Morbidity and Mortality Weekly Report, the guidelines note that while antibiotic resistance in N meningitidis has been uncommon in the United States, 29 cases of invasive meningococcal disease caused by ciprofloxacin-resistant strains were reported from 2019 to 2021, distributed across the United States but with clusters identified in some geographic areas. Ciprofloxacin is one of the recommended first-line options for treating patients and for prophylaxis for their close contacts, who are at increased risk of acquiring the disease.
To date, no instances of prophylaxis failure associated with ciprofloxacin resistance has been reported. But because of the high mortality risk of invasive meningococcal disease and the potential for prophylaxis failure, the CDC says the threshold for changing the antibiotic prophylaxis recommendation is low.
When other antibiotics should be considered
Under the new guidelines, the CDC recommends other antibiotics be considered if, over a rolling 12-month period, two or more invasive meningococcal disease cases caused by ciprofloxacin-resistant strains are reported in a local catchment area and 20% or more of the invasive meningococcal disease cases in that area are caused by ciprofloxacin-resistant strains.
Other recommended options for prophylaxis include rifampin, ceftriaxone, and azithromycin. The CDC says local health departments have flexibility in guidance implementation.
"Ongoing monitoring for antibiotic resistance of meningococcal isolates through surveillance and health care providers' reporting of prophylaxis failures will guide future updates to prophylaxis considerations and recommendations," the authors wrote.