February 26th, 2009

Meningococcal Resistance to Ciprofloxacin

Ciprofloxacin-resistant Neisseria meningitidis has now been documented in the United States. Here’s a nice summary in Journal Watch, with two different perspectives.

I suppose we shouldn’t be surprised, but it did take a while.  (At least compared to that other famous neisseria-bug, Neisseria gonorrhoeae.)

Oh well.

Why is this important?  As every practicing ID doc/primary care provider/public health official knows, nothing strikes fear into a community quite like a case of invasive meningococcal disease.  Since household contacts of these cases have a many-fold increased risk of developing the disease, preventive therapy is recommended for any close contact — with “close” being defined nicely by one infection-control practitioner I know as “coughing distance.”

But we all know that prophylaxis extends way beyond this — not surprisingly, many more people request and get preventive therapy than actually need it, and in part this is because it’s so easy to do:  a single dose of ciprofloxacin.

Now this needs to be reconsidered.  Although it’s up to each local department of health to determine the recommended preventive therapy, I suspect it won’t be long before we’re all back to rifampin (four doses over two days, drug interactions) or a shot of ceftriaxone (ouch).

3 Responses to “Meningococcal Resistance to Ciprofloxacin”

  1. Gerald says:

    Unfortunate phrasing, to say that cipro-resistant Neisseria meningitidis has just been documented in the US. It’s been endemic in the US state of Hawaii for many years. For example, see http://hawaii.gov/health/about/healthy-lifestyles/std-aids/info-medical-providers/index.html#6.

  2. Gerald says:

    Crimony–hoisted by my own unfortunate mind-block: I was reading Neisseria gonorrhoeae (is that the species shown in the artificially-colored image?) while reading and typing Neisseria meningitidis. Forgive my mistaken comment.

  3. Paul Sax says:

    Gerald, my images are obtained from that highly-scientific web site aggregating machine, “Google Images”.

    This particular one came from a U of Wisconsin educational site that at least said this image was N meningitidis. MultipleOrganisms.net

HIV Information: Author Paul Sax, M.D.

Paul E. Sax, MD

Contributing Editor

NEJM Journal Watch
Infectious Diseases

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