Prophylactic Treatment for Exposure to Bacterial Meningitis

Recommended Prophylactic Antibiotics

The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend ciprofloxacin 500 mg oral single dose for adults over 16 years as a prophylactic antibiotic for exposure to bacterial meningitis 1, 2
The Centers for Disease Control and Prevention recommend rifampin 600 mg orally twice daily for 2 days as a prophylactic antibiotic for exposure to bacterial meningitis 1, 2
The American Academy of Pediatrics recommends ceftriaxone 250 mg intramuscular single dose as a prophylactic antibiotic for exposure to bacterial meningitis 1, 2
For children, the Centers for Disease Control and Prevention recommend rifampin 5 mg/kg twice daily orally for 2 days for those under 3 months, 10 mg/kg twice daily orally for 2 days for those 3 months to 12 years, and 600 mg twice daily orally for 2 days for those over 12 years 1, 2
For children, the American Academy of Pediatrics recommends ceftriaxone 125 mg intramuscular single dose as a prophylactic antibiotic for exposure to bacterial meningitis 1, 2

The Centers for Disease Control and Prevention recommend that household members, child care center contacts, and anyone directly exposed to oral secretions of the patient should receive prophylaxis 1, 2, 5

Prophylactic antibiotic treatment has been proven effective in preventing secondary cases and eradicating meningococcal carriage, with the risk of meningococcal disease increased 400-800 fold in close contacts of patients with meningococcal disease 2, 5
A Cochrane meta-analysis found ceftriaxone, rifampin, and ciprofloxacin to be the most effective prophylactic antibiotics 2

Droplet precautions should be implemented for exposed individuals until they have received 24 hours of effective antibiotic prophylaxis, and monitoring for symptoms of meningococcal disease should continue for at least 10 days after exposure, even after receiving prophylaxis 3

Vaccination with pneumococcal vaccine is recommended after an episode of pneumococcal meningitis, and vaccination is beneficial in patients with CSF leakage to reduce recurrences 1, 2