Patient with Suspected Meningitis Age > 56 days — Chemoprophylaxis — Clinical Pathway: Emergency, Inpatient

Suspected Meningitis Age > 56 days Clinical Pathway — Emergency Department, Inpatient and ICU

Chemoprophylaxis for Neisseria meningitidis and Haemophilus influenzae

Chemoprophylaxis for Neisseria meningitidis

Hospital exposure

Indications for Neisseria meningitidis prophylaxis

  • Any household contact, especially children younger than 2 years
  • Child care or preschool contact at any time during 7 days before onset of illness
  • Any contact with direct exposure to index patient’s secretions through kissing or through sharing toothbrushes or eating utensils, markers of close social contact, at any time during 7 days before onset of illness
  • Anyone who has performed mouth-to-mouth resuscitation, or had unprotected contact during endotracheal intubation at any time 7 days before onset of illness
  • Anyone who frequently slept in same dwelling as index patient during 7 days before onset of illness
  • Passengers seated directly next to the index case during airline flights lasting more than 8 hours

For initial management of hospital exposures to Neisseria meningitidis, refer to the CHOP Job Aid titled “Procedure: Occupational Health Management of Staff Meningococcal Exposure”. Infection Prevention and Control and Occupational Health should both be notified. View Job Aid

Prophylaxis for Neisseria meningitidis is indicated for those who fit the following categories:

  • Any household contact, especially children younger than 2 years
  • Child care or preschool contact at any time during 7 days before onset of illness
  • Any contact with direct exposure to index patient’s secretions through kissing or through sharing toothbrushes or eating utensils, markers of close social contact, at any time during 7 days before onset of illness
  • Anyone who has performed mouth-to-mouth resuscitation, or had unprotected contact during endotracheal intubation at any time 7 days before onset of illness
  • Anyone who frequently slept in same dwelling as index patient during 7 days before onset of illness
  • Passengers seated directly next to the index case during airline flights lasting more than 8 hours

Recommended Chemoprophylaxis Regimens for Eligible Contacts
(give either rifampin or ceftriaxone)

Age of Infants, Children, and Adults Dose Duration Cautions
Rifampin
< 1 month 5 mg/kg, orally, every 12 hours 2 days  
≥ 1 month 10 mg/kg (maximum 600 mg), orally, every 12 hours 2 days Can interfere with efficacy of oral contraceptives and some seizure and anticoagulant medications
Ceftriaxone
< 15 years 125 mg, intramuscularly Single dose To decrease pain at injection site, dilute with 1% lidocaine  
≥ 15 years 250 mg, intramuscularly Single dose To decrease pain at injection site, dilute with 1% lidocaine  

Chemoprophylaxis for Haemophilus influenzae

Indications for Haemophilus influenzae type b prophylaxis

  • All household contacts in the following circumstances:
    • Household with at least 1 contact younger than 4 years of age who is unimmunized or incompletely immunized
    • Household with a child younger than 12 months of age who has not completed the primary Hib series
    • Household with a contact who is an immunocompromised child, regardless of that child’s Hib immunization status or age
  • For preschool and child care center contacts when 2 or more cases of Hib invasive disease have occurred within 60 days
  • For index patients younger than 2 years of age or who have susceptible contacts at home, if treated with a regimen other than ceftriaxone, should receive rifampin prophylaxis at the end of therapy

Recommended Chemoprophylaxis Regimens for Eligible Contacts

Age Dose Duration Cautions
Rifampin
All ages 20 mg/kg (maximum 600 mg), orally, once daily 4 days Dose for children younger than 1 month is not established. Some experts recommend 10 mg/kg, orally, once daily, for 4 days.

Can interfere with efficacy of oral contraceptives, some seizure and anticoagulant medications.