A 26-year-old day care worker comes to the clinic after prolonged close contact with a child who has meningococcal meningitis. She has a history of irritable bowel syndrome. The patient's current medications include oral contraceptives and a multivitamin. She is concerned about her risk for acquiring meningitis and asks for advice. Which of the following is the most appropriate next step?

Question

A 26-year-old day care worker comes to the clinic after prolonged close contact with a child who has meningococcal meningitis.  She has a history of irritable bowel syndrome.  The patient's current medications include oral contraceptives and a multivitamin.  She is concerned about her risk for acquiring meningitis and asks for advice.  Which of the following is the most appropriate next step?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfae_b0ea_8f63_2be690bffed2_MD0005_00 Individuals in close contact with patients having known invasive meningococcal infection should be prescribed prophylactic antibiotics to eradicate pharyngeal carriage of the organism. Close contact is usually defined either as >8 hours of exposure in close proximity (<3 feet) to the affected patient or as direct exposure to respiratory secretions within 7 days of onset of the affected patient's symptoms. Close contacts include household members, roommates or intimate contacts, child care workers (such as this patient), airline travelers seated next to the affected patient during an extended flight, and those having had direct exposure to oral secretions. Health care workers do not need prophylactic antibiotics unless the workers are directly exposed to respiratory secretions (eg, mouth-to-mouth resuscitation, endotracheal intubation). Antimicrobial chemoprophylaxis should be administered as early as possible, ideally within 24 hours of exposure to the affected patient. Prophylaxis given >14 days after exposure has limited efficacy and is not recommended. Recommended regimens include rifampin (600 mg orally twice daily for 2 days), ciprofloxacin (500 mg single oral dose), and ceftriaxone (250 mg single dose). All 3 regimens are effective in decreasing the spread of meningococcal infection. However, rifampin (generally preferred) interacts with oral contraceptive pills (OCPs) to decrease their efficacy. Rifampin increases hepatic clearance of OCPs, which leads to reduced serum concentrations of sex hormones (eg, ethinyl estradiol, levonorgestrel, norethindrone) and gonadotropins. As a result, patients on OCPs may ovulate and therefore require an alternate form of birth control during ovulation. Ciprofloxacin and ceftriaxone do not have significant interactions with OCPs and would therefore be better options for this patient (Choice D). (Choices A and E) This patient is a child care worker who requires prophylaxis, but she is asymptomatic and does not need hospital admission or quarantine. (Choice C) Penicillin can be effective but is not the preferred choice for chemoprophylaxis against meningococcal meningitis. Educational objective: Close contacts (eg, household members, roommates or intimate contacts, child care workers, persons having had direct exposure to oral or respiratory secretions) of patients with known meningococcal meningitis should receive chemoprophylaxis. Regimens include rifampin (preferred), ciprofloxacin, and ceftriaxone. Ciprofloxacin and ceftriaxone are acceptable regimens in patients who cannot take rifampin (eg, women taking oral contraceptive pills). References: Drug interactions between oral contraceptives and antibiotics. (http://www.ncbi.nlm.nih.gov/pubmed/11704183) Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP) (http://www.ncbi.nlm.nih.gov/pubmed/23515099) Antibiotics for preventing meningococcal infections. (http://www.ncbi.nlm.nih.gov/pubmed/24163051)

A 26-Year-Old Day Care Worker Comes to the Clinic After