The New York Department of Health has issued an advisory to providers, recommending that use of ciprofloxacin for invasive meningococcal disease post-exposure prophylaxis be discontinued due to increasing antimicrobial resistance.
The advisory suggests that rifampin or ceftriaxone be prescribed instead for the same purpose, and it stresses that “treatment recommendations for suspected or confirmed invasive meningococcal disease have not changed.”
Invasive meningococcal disease is “a rare but severe infection caused by Neisseria meningitidis that can present with meningitis, blood stream infection, septic arthritis, or pneumonia. In the United States, approximately 10-15% of cases are fatal. Providing antibiotic post-exposure prophylaxis to close contacts of people with invasive meningococcal disease is an essential disease prevention strategy.”
According to the advisory, “four of 20 (20%) N. meningitidis isolates collected from patients with invasive meningococcal disease residing in New York State but outside New York City (NYC) were resistant to ciprofloxacin in 2023,” and in New York City, six of 35 collected isolates were resistant. This approaches the CDC-recommended threshold for “discontinuing ciprofloxacin post-exposure prophylaxis in a local catchment area…to prevent prophylaxis failure.”
