Download Antibiotic Prophylaxis Following an Exposure to Meningitis

Antibiotic Prophylaxis Following an Exposure to Meningitis
Few situations provoke more anxiety amongst healthcare workers than the presence of a
patient with meningitis. Just mentioning that a patient might have meningitis prompts a
sometimes surprising amount of concern. Questions always arise about whom, if anyone,
should receive antibiotics following an exposure. Here are a few facts:
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Preventative antibiotics are of no use following exposure to meningitis caused by
Haemophilus influenza, Streptococcus pneumoniae, Listeria monoctogenes,
Cryptococcal meningitis, viral (aseptic) meningitis, or West Nile Fever.
Antibiotics are occasionally useful following exposure to patients with Neisseria
meningitidis, the cause of meningococcal meningitis. It is transmitted by large
droplets expelled by coughing or sneezing.
Indications for antibiotics following exposure to a case of meningococcal
meningitis are few, especially for healthcare workers. Antibiotics are of benefit to
those living in households with cases. These household contacts have prolonged
and more extensive contact with the affected patient than healthcare workers.
Administration of antibiotics is occasionally of benefit to healthcare workers. It is
advisable in individuals who have performed mouth-to-mouth resuscitation or
endotracheal intubation on a known or suspected case of meningococcal disease.
Otherwise, healthcare workers are not at increased risk of acquiring disease or
of taking it home to family members.
A few facts to support this reasoning:
• Chronic asymptomatic carriage of Neisseria meningiditis in the U.S. population is
common. 5-10% of people carry the germ in the nasopharynx. As such, you’re
probably exposed to it all the time. Few people actually become sick.
• Antibiotics used to prevent meningitis can have serious, even fatal side-effects.
Some are contraindicated in pregnancy. Some may lessen effectiveness of oral
contraceptives. The antibiotic, if you don’t truly need it, is a bigger risk to your
health than the germ. Also, unnecessary use promotes the emergence of antibiotic
resistant bacteria.
• Twenty-four hours of effective antibiotic therapy renders a patient non-infectious.
If they are transferred form outside our institution, they may have already been
treated and not be infectious any longer.
The Student-Employee Health Service and the Infection Control Department discourages
the usage of preventative antibiotics in all but the circumstances described above.
Effective antibiotics regimens include:
• Rifampin 600mg orally twice daily for two days
• Ciprofloxacin 500mg orally as a single dose
• Ceftriaxone 250mg as a single intra-muscular injection
If you are concerned that you have been exposed please contact the Student-Employee
Health Service at 41185 or the Infection Control Department at 42188. Evenings and
weekends, contact the Adult Emergency Department Preventative antibiotics are
provided free of charge to those employees that the Director of Student Employee Health
feels had a significant exposure as described above.