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Transcript
MENINGOCCUS CHEMOPROPHYLAXIS STANDING ORDERS INTRODUCTION The purpose of chemoprophylaxis for individuals who have been in contact with a person who has developed meningococcal infection is to prevent these individuals from developing meningococcal infection themselves. This in turn prevents them from spreading the infection as well. INDICATIONS Chemoprophylaxis is appropriate for individuals who have been exposed to a patient who has meningococcal infection or who were exposed to that person within the 7 days prior to the time when the patient became symptomatic with meningococcal infection. An exposed person is defined as one who is a household member, child care center or nursery school participant, or who has had contact with oral secretions of the case such as sharing food and beverage, kissing, and handling of soiled facial tissues or other objects. PROPHYLAXIS NEEDS TO BE INITIATED AS SOON AS POSSIBLE AFTER DIAGNOSIS OF THE INDEX CASE. IF AT ALL POSSIBLE, IT SHOULD BE STARTED WITHIN 24 HOURS OF DIAGNOSIS OF THE PRIMARY CASE. Close surveillance of intimate contacts is important and if symptoms develop, evaluate immediately for treatment. A letter of explanation is sent to the intimate contacts if the Medical Director approves it. CONTRAINDICATIONS No person should receive a medication to which it is reasonably suspected that they are allergic. Individuals with reasonable suspicion of liver disease should not receive rifampin until discussing the case with the medical director. If a person may makes an informed decision against receiving chemoprophylaxis, they should not receive it. DRUGS OF CHOICE When sensitivity of an organism is unknown, the drugs of choice are: For children less than 18 years old: rifampin For non-pregnant adults: ciprofloxacin For pregnant adults: ceftriaxone Individuals who are allergic to the above drug of choice should receive an alternate effective drug after consultation with the medical director regarding specific choice of medication. Meningococcus Chemoprophylaxis Standing Order, Page 1 of 2 DOSAGE AND ADMINISTRATION Rifampin Dosage is given every 12 hours for 48 hours - 4 total doses Children under 1 month old - 5 mg/kg 6.6 lb. 3 kg 15 mg 11 lb. 5 kg 25 mg 22 lb 10 kg 50 mg Adults and Children over 1 month old - 10 mg/kg 15 lb. 7.5 kg 75 mg 33-49 lbs. 15-22.5 kg 150 mg 50-82 lbs. 22.6-37.5 kg 300 mg 83-115 lbs. 37.6-52.5 kg 450 mg > 116 lbs. 52.6-60 kg 600 mg *Rifampin causes urine to turn red, and discolors all body fluids (remove contact lenses). Must use back-up method if on birth control pills. Cipro Dosage is 500 mg as a single oral dose Ceftriaxone For children < 12 years old, use 125 mg IM as a single dose For children > 12 years old and for adults, use 250 mg IM as a single dose REFERENCES American Academy of Pediatrics. Meningococcal Infections. In: Peter G, ed. 1997 Red Book: Report of the Committee on Infectious Diseases. 24th ed. Elk Grove Village, IL DISTRIBUTION Public Health Nurses Director of Nursing John R. Spriegel, M.D., M.P.H. Medical Director Date Rev: 9/8/1999 StandingOrders/MeningococcusProphylaxis.doc Meningococcus Chemoprophylaxis Standing Order, Page 2 of 2