A 16-year-old boy is brought to the emergency department via ambulance. The school nurse who accompanied him informs the physician that he has had 2 days of headache and generalized body aches that did not respond to acetaminophen. He felt well enough to attend school and to work his part-time job at a local hardware store. However, this morning his headache worsened and he was extremely drowsy. The paramedics administered intravenous normal saline; no other interventions were required during transport. In the emergency department, he becomes lethargic, has a seizure, and is immediately intubated by the resident physician. Subsequent evaluation reveals that the patient is suffering from acute meningococcal meningitis. The individuals requiring antibiotic prophylaxis are identified and contacted. Which of the following is the most appropriate therapy for chemoprophylaxis against meningococcal meningitis?

Question

A 16-year-old boy is brought to the emergency department via ambulance.  The school nurse who accompanied him informs the physician that he has had 2 days of headache and generalized body aches that did not respond to acetaminophen.  He felt well enough to attend school and to work his part-time job at a local hardware store.  However, this morning his headache worsened and he was extremely drowsy.  The paramedics administered intravenous normal saline; no other interventions were required during transport.  In the emergency department, he becomes lethargic, has a seizure, and is immediately intubated by the resident physician.  Subsequent evaluation reveals that the patient is suffering from acute meningococcal meningitis. The individuals requiring antibiotic prophylaxis are identified and contacted.  Which of the following is the most appropriate therapy for chemoprophylaxis against meningococcal meningitis?

Quizplus · Accepted Answer

Explanation: 11ec2b69_bfaf_c25c_8f63_ffb046a6d00b_MD0005_00 Antibiotic chemoprophylaxis is used to decolonize close contacts of patients with meningococcal meningitis, as they may carry the same invasive strain. To prevent secondary cases, selected agents need to be highly efficacious and easy to adhere to. Oral rifampin (every 12 hours for a total of 4 doses) is the recommended regimen. Ciprofloxacin and intramuscular ceftriaxone can also be used. Other antibiotics are either less effective or more difficult to administer. (Choices A and D) Penicillins or aminopenicillins (ie, amoxicillin) do not have activity against meningococcus. (Choice B) Cefuroxime is a second-generation cephalosporin that has poor activity against meningococcus. (Choice C) Tobramycin has activity against meningococcus. However, inhaled tobramycin is difficult to administer, does not reliably reach the nasopharynx, and has not been shown to be effective for decolonization. Educational objective: Oral rifampin is the recommended chemoprophylaxis for high-risk contacts of patients with invasive meningococcal disease. Other commonly used regimens are a single oral dose of ciprofloxacin or a single intramuscular injection of ceftriaxone. References: Prevention and control of meningococcal disease: recommendations of the Advisory Committee on Immunization Practices (ACIP) (http://www.ncbi.nlm.nih.gov/pubmed/23515099) Principles of antibiotic prophylaxis (http://www.ncbi.nlm.nih.gov/pubmed/24360302)

A 16-Year-Old Boy Is Brought to the Emergency Department Via