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Contact prophylaxis for invasive meningococcal or Hib disease

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    PIC Endorsed
  • See also

    Acute meningococcal disease
    Meningitis and encephalitis

    Organism

    Antibiotic

    Those requiring prophylaxis

    N. meningitidis

    Ciprofloxacin
    30 mg/kg (max 125 mg) (<5 years), 250 mg (5-12 years), 500 mg (12 years) PO as a single dose

    Young children:
    Rifampicin 5 mg/kg (<1 month), 10 mg/kg (max 600 mg) (1 month) PO bd for 2 days

    Pregnancy/contraindication to Rifampicin:
    Ceftriaxone 250 mg (12 years) 125 mg (<12 years) IM as a single dose or
    Ciprofloxacin 30 mg/kg (max 125 mg) (<5 years), 250 mg (5-12 years) 500 mg (12 years) PO as a single dose

    Index case (if treated only with penicillin) and all intimate household or day care contacts who have been exposed to index case within 10 days of onset.

    Any person who gave mouth-to-mouth resuscitation to the index case

    HiB

    Rifampicin 20mg/kg (max 600 mg) PO daily for 4 days

    Infants <1 month:
    Rifampicin 10 mg/kg PO daily for 4 days

    Pregnancy/contraindication to Rifampicin:
    Ceftriaxone 250 mg IM daily for 2 days

    Index case and all household contacts if household includes other children <4 years of age who are not fully immunised.

    Index case and all household contacts in households with any infants <12 months of age, regardless of immunisation status.

    Index case and all household contacts in households with a child 1–5 years of age who is inadequately immunised.

    Index case and all room contacts, including staff, in a childcare group if index case attends >18 hours per week and any contacts <2 years of age who are inadequately immunised.

    AND children who are not up to date with Hib should be immunised.

    S. pneumoniae            

    Nil

    No increased risk to contacts

    Notes:

    • Prophylaxis must be given early to both the index case and contacts, especially for N. meningitidis disease, because of the rapidity with which secondary cases may develop
    • Rifampicin interferes with the metabolism of several medications, including the oral contraceptive pill (alternative contraception should be instituted), anticonvulsants, warfarin and chloramphenicol
    • Rifampicin colours body fluids red, for example urine, saliva, tears (soft contact lenses may be damaged), sweat