rifampin and Meningitis--Meningococcal

Topics: Bacterial Vaccines; Humans; Meningitis, Meningococcal; Neisseria meningitidis; Rifampin; Serotyping

Cefotaxime and ceftriaxone are currently the agents of first choice for empiric treatment of bacterial meningitis in children. Further studies are necessary to determine the optimal antibiotic therapy for meningitis caused by Streptococcus pneumoniae isolates relatively or fully resistant to penicillin. The Haemophilus influenzae type b capsular polysaccharide-protein conjugate vaccines undoubtedly will alter the relative importance of the three common meningeal pathogens in pediatrics and make additional studies of the adjunctive use of dexamethasone in the treatment of bacterial meningitis even more critical.

Topics: Anti-Bacterial Agents; Anti-Inflammatory Agents; Bacterial Capsules; Bacterial Vaccines; Dexamethasone; Haemophilus influenzae; Haemophilus Vaccines; Humans; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Pneumococcal Vaccines; Polysaccharides, Bacterial; Rifampin; Streptococcus pneumoniae

Topics: Anti-Infective Agents; Child; Child, Preschool; Humans; Leucomycins; Meningitis, Haemophilus; Meningitis, Meningococcal; Minocycline; Rifampin; Risk; Sulfonamides

N. meningitidis continues to be a worldwide cause of human disease, usually in otherwise healthy individuals. The natural habitat and reservoir for meningococci are the mucosal surfaces of the human nasopharynx and to a lesser extent, the urogenital tract and anal canal. In most instances meningococcal colonization of mucosal surfaces is asymptomatic but may produce local infection. In those individuals who lack serum bactericidal activity against the meningococcus, colonization of mucosal surfaces and bloodstream invasion by N. meningitidis can lead to devastating meningitis and septicemia. Recent studies on the ultrastructure of the meningococcus and on the mechanisms of pathogenesis have given us new insight into meningococcal infections and suggest ways for improved immunoprophylaxis. Currently, penicillin is the drug of choice for the treatment of meningococcal meningitis and septicemia. However, the report of meningococci with antibiotic resistant plasmids is alarming and in the future may alter traditional treatment regimens.

Topics: Cephalosporins; Chloramphenicol; Humans; Meningitis, Meningococcal; Neisseria meningitidis; Penicillins; Rifampin; Serotyping

Topics: Adolescent; Adult; Age Factors; Carrier State; Child; Child, Preschool; Disease Outbreaks; Drug Resistance, Microbial; Humans; Infant; Infant, Newborn; Meningitis, Meningococcal; Rifampin; Seasons; Sulfonamides; Vaccination

Topics: Ampicillin; Bacterial Infections; Brain Edema; Child, Preschool; Chloramphenicol; Cloxacillin; Gentamicins; Haemophilus influenzae; Humans; Infant; Infant, Newborn; Injections, Spinal; Meningitis; Meningitis, Haemophilus; Meningitis, Meningococcal; Meningitis, Pneumococcal; Methicillin; Minocycline; Neisseria meningitidis; Penicillin G; Rifampin; Seizures; Shock; Streptococcus pneumoniae; Sulfonamides

Topics: Adolescent; Adult; Age Factors; Carrier State; Child; Child, Preschool; Disease Outbreaks; Female; Humans; Infant; Male; Meningitis, Meningococcal; Minocycline; Neisseria meningitidis; Penicillins; Rifampin; Seasons; Serotyping; Sex Factors; Sulfonamides; Vaccination

During an outbreak of meningococcal meningitis in Saudi Arabia, oral rifampicin (four doses in two days) was compared with a single intramuscular dose of ceftriaxone for prophylaxis in family contacts of patients with meningococcal disease. Pharyngeal samples were taken for culture before and 1 and 2 weeks after administration. Both follow-up cultures indicated that ceftriaxone was significantly more effective. At 1 week the eradication rates for ceftriaxone and rifampicin were 97% and 75%; at 2 weeks they were 97% and 81%, respectively. No serious side-effects were associated with either agent. Ceftriaxone may provide an effective alternative to rifampicin for prophylaxis in meningococcal contacts.

Topics: Administration, Oral; Adolescent; Adult; Carrier State; Ceftriaxone; Clinical Trials as Topic; Disease Outbreaks; Drug Evaluation; Female; Follow-Up Studies; Humans; Injections, Intramuscular; Male; Meningitis, Meningococcal; Microbial Sensitivity Tests; Neisseria meningitidis; Oropharynx; Random Allocation; Recurrence; Rifampin; Saudi Arabia

Topics: Adolescent; Adult; Age Factors; Carrier State; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Male; Meningitis, Meningococcal; Neisseria meningitidis; Nigeria; Rifampin; Sex Factors; Sulfamethazine

Topics: Adult; Ampicillin; Anti-Bacterial Agents; Carrier State; Clinical Trials as Topic; Humans; Male; Meningitis, Meningococcal; Military Medicine; Penicillin Resistance; Placebos; Rifampin

Topics: Adult; Aspartate Aminotransferases; Carrier State; Clinical Trials as Topic; Drug Resistance, Microbial; Humans; L-Lactate Dehydrogenase; Male; Meningitis, Meningococcal; Microbial Sensitivity Tests; Military Medicine; Neisseria meningitidis; Rifampin; Serotyping

Invasive meningococcal disease (IMD), caused by Neisseria meningitidis, can have a fatality rate as high as 10%, even with appropriate treatment. In the UK, penicillin is administered to patients in primary care whilst third generation cephalosporins, cefotaxime and ceftriaxone, are administered in secondary care. The first-choice antibiotic for chemoprophylaxis of close contacts is ciprofloxacin, followed by rifampicin. Immunocompromised individuals are often recommended antibiotic chemoprophylaxis and vaccination due to a greater risk of IMD. Resistance to antibiotics among meningococci is relatively rare, however reduced susceptibility and resistance to penicillin are increasing globally. Resistance to third generation cephalosporins is seldom reported, however reduced susceptibility to both cefotaxime and ceftriaxone has been observed. Rifampicin resistance has been reported among meningococci, mainly following prophylaxis, and ciprofloxacin resistance, whilst uncommon, has also been reported across the globe. The Public Health England Meningococcal Reference Unit receives and characterises the majority of isolates from IMD cases in England, Wales and Northern Ireland. This study assessed the distribution of antibiotic resistance to penicillin, rifampicin, ciprofloxacin and cefotaxime among IMD isolates received at the MRU from 2010/11 to 2018/19 (n = 4,122). Out of the 4,122 IMD isolates, 113 were penicillin-resistant, five were ciprofloxacin-resistant, two were rifampicin-resistant, and one was cefotaxime-resistant. Penicillin resistance was due to altered penA alleles whilst rifampicin and ciprofloxacin resistance was due to altered rpoB and gyrA alleles, respectively. Cefotaxime resistance was observed in one isolate which had an altered penA allele containing additional mutations to those harboured by the penicillin-resistant isolates. This study identified several isolates with resistance to antibiotics used for current treatment and prophylaxis of IMD and highlights the need for continued surveillance of resistance among meningococci to ensure continued effective use.

Topics: Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Drug Resistance, Microbial; England; Humans; Meningitis, Meningococcal; Neisseria meningitidis; Northern Ireland; Penicillins; Rifampin; Wales

Determination of the major serogroups is an important step for establishing a vaccine programme and management strategy targeting Neisseria meningitidis. From April 2010 to November 2016, a total of 25 N. meningitidis isolates were collected in South Korea, in collaboration with the Korean Society of Clinical Microbiology. Among isolates, 19 isolates were recovered from blood and/or cerebrospinal fluid (CSF) in 46 patients who suffered from invasive meningococcal disease (IMD), and six isolates were found in sputum or the throat. The most common serogroup was serogroup B (overall, 36%, n = 9/25; IMD, 37%, n = 7/19), which was isolated in every year of the research period except for 2011. There were five serogroup W isolates recovered from patients in military service. W was no longer isolated after initiation of a vaccine programme for military trainees, but serogroup B caused meningitis in an army recruit training centre in 2015. In MLST analysis, 14 sequence types were found, and all isolates belonging to W showed the same molecular epidemiologic characteristics (W:P1.5-1, 2-2:F3-9:ST-8912). All isolates showed susceptibility to ceftriaxone, meropenem, ciprofloxacin, minocycline, and rifampin; however, the susceptibility rates to penicillin and ampicillin for isolates with W and C capsules were 22% and 30%, respectively.

Topics: Adolescent; Adult; Aged; Ceftriaxone; Child; Child, Preschool; Ciprofloxacin; Drug Resistance, Bacterial; Female; Humans; Infant; Male; Meningitis, Meningococcal; Meningococcal Infections; Meropenem; Microbial Sensitivity Tests; Middle Aged; Minocycline; Multilocus Sequence Typing; Neisseria meningitidis; Neisseria meningitidis, Serogroup B; Neisseriaceae Infections; Prevalence; Republic of Korea; Rifampin; RNA, Ribosomal, 16S; Serogroup

On December 11, 2015, the Fort Wayne-Allen County (Indiana) Department of Health was notified by a local hospital laboratory of a suspected case of meningococcal meningitis based on Gram stain results of cerebrospinal fluid. The county health department interviewed close family members and friends of the patient to establish an infectious period, timeline of events, and possible exposures. Close medical and household contacts were offered chemoprophylaxis (1). This case was associated with an elementary school. The patient had intermittent, close, potentially face-to-face contact with many students, and was reported to have had a persistent, productive cough throughout the exposure period. In light of these unusual circumstances, and the fact that elementary school-aged children are not routinely vaccinated against meningococcal disease,* local and state health officials, with CDC support, decided to offer chemoprophylaxis to the patient's contacts. A total of 581 child and adult contacts were identified.

Topics: Adult; Child; Ciprofloxacin; Contact Tracing; Female; Humans; Indiana; Male; Meningitis, Meningococcal; Neisseria meningitidis, Serogroup B; Practice Guidelines as Topic; Pregnancy; Rifampin; Schools

Bacterial meningitis among critically ill adult patients remains associated with both high mortality and frequent, persistent disability. Vancomycin was added to treatment with a third-generation cephalosporin as recommended by French national guidelines. Because animal model studies had suggested interest in the use of rifampin for treatment of bacterial meningitis, and after the introduction of early corticosteroid therapy (in 2002), there was a trend toward increasing rifampin use for intensive care unit (ICU) patients. The aim of this article is to report on this practice.. Five ICUs participated in the study. Baseline characteristics and treatment data were retrospectively collected from charts of patients admitted with a diagnosis of acute bacterial meningitis during a 5-year period (2004-2008). The ICU mortality was the main outcome measure; Glasgow Outcome Scale and 3-month mortality were also assessed.. One hundred fifty-seven patients were included. Streptococcus pneumoniae and Neisseria meningitidis were the most prevalent causative microorganisms. The ICU mortality rate was 15%. High doses of a cephalosporin were the most prevalent initial antimicrobial treatment. The delay between admission and administration of the first antibiotic dose was correlated with ICU mortality. Rifampin was used with a cephalosporin for 32 patients (ranging from 8% of the cohort for 2004 to 30% in 2008). Administration of rifampin within the first 24 h of hospitalization could be associated with a lower ICU survival. Statistical association between such an early rifampin treatment and ICU mortality reached significance only for patients with pneumococcal meningitis (p=0.031) in univariate analysis, but not in the logistic model.. We report on the role of rifampin use for patients with community-acquired meningitis, and the results of this study suggest that this practice may be associated with lower mortality in the ICU. Nevertheless, the only independent predictors of ICU mortality were organ failure and pneumococcal infection. Further studies are required to confirm these results and to explain how rifampin use would reduce mortality.

Topics: Anti-Bacterial Agents; Community-Acquired Infections; Female; France; Glasgow Outcome Scale; Hospital Mortality; Humans; Intensive Care Units; Male; Meningitis, Bacterial; Meningitis, Meningococcal; Meningitis, Pneumococcal; Middle Aged; Neisseria meningitidis; Retrospective Studies; Rifampin; Treatment Outcome

We report a secondary case of rifampicin-resistant meningococcal disease and our experience in managing contact cases. Rifampicin resistance resulting from rpoB gene mutations is still uncommon enough that changing the current recommendations for chemoprophylaxis is unwarranted. However, ensuring limited but appropriate chemoprophylaxis may prevent the development of antimicrobial resistance. Thus, the definition of contact cases should be strictly respected. In the case of culture-positive Neisseria meningitidis, in vitro susceptibility testing to rifampicin must be systematically performed in order to detect rifampicin-resistant strains and, thus, institute appropriate prophylaxis in order to prevent secondary transmission.

Topics: Adolescent; Anti-Bacterial Agents; Antibiotic Prophylaxis; Drug Resistance, Bacterial; Female; Humans; Meningitis, Meningococcal; Microbial Sensitivity Tests; Neisseria meningitidis; Rifampin

To analyze the profile of antimicrobial susceptibility of meningococcal disease isolates collected throughout Brazil from 2006 to 2008 and forwarded to the National Reference Laboratory for Meningitis, Institute Adolfo Lutz - São Paulo.. The MIC to penicillin, ampicillin, chloramphenicol, ceftriaxone, ciprofloxacin and rifampicin was determined in a sample of 1096 (55% of the total isolates received) randomly chosen using the broth microdilution procedure. The breakpoints used were those recommended by the European Monitoring Group on Meningococci (EMGM).. Decreased susceptibility to penicillin and ampicillin was detected in 13% and 12.9% respectively. All isolates were susceptible to chloramphenicol, ceftriaxone, and ciprofloxacin. Two strains (0.2%) showed high resistance to rifampicin and 0.5% of the isolates displayed intermediate resistance to rifampicin.. The meningococcal strains isolated in Brazil during 2006-2008 were globally susceptible to all antibiotics currently used in treatment or chemoprophylaxis of meningococcal disease in Brazil.

Topics: Adolescent; Adult; Anti-Bacterial Agents; beta-Lactams; Brazil; Child; Child, Preschool; Chloramphenicol; Ciprofloxacin; Drug Resistance, Multiple, Bacterial; Female; Humans; Infant; Male; Meningitis, Meningococcal; Microbial Sensitivity Tests; Neisseria meningitidis; Rifampin; Serotyping; Species Specificity; Young Adult

The objective of this study was to characterize the phenotype and genotype of two isolates of rifampicin-resistant Neisseria meningitidis associated with two independent events involving transmission of severe meningococcal meningitis that occurred in September and October 2010 in Montevideo, Uruguay. The most recent 10 years of data from the national antimicrobial resistance surveillance system were reviewed to estimate the frequency of the particular meningococcal features that were characterized. Rifampicin resistance was studied using the epsilometer test. The serotype and serosubtype of the isolates were determined by ELISA, and the genotype was characterized using DNA digestion with Nhel and pulse field gel electrophoresis. The two isolates were identical: B:2a:P1.5. In the collection of 408 strains of N. meningitidis isolated in Uruguay in the past 10 years, the phenotype only appeared in two isolates, which were sensitive to rifampicin. The two isolates studied also shared a single pulse type, which was different from that of two other rifampicin-resistant isolates obtained in 2003 and 2007. Consequently, it was concluded that both cases of transmission were caused by a single rifampicin-resistant strain, which could have been an import from another country or else the result of a drift from serogroup C to B due to selective pressure exerted by vaccines administered to the population. It is essential to maintain and maximize surveillance. However, since this type of finding has been sporadic so far, unless a secondary case is identified, there is no justification for changing the antimicrobial drug currently being administered to contacts as prophylaxis.

Topics: Adolescent; Child, Preschool; DNA, Bacterial; Electrophoresis, Gel, Pulsed-Field; Genotype; Humans; Male; Meningitis, Meningococcal; Neisseria meningitidis, Serogroup B; Neisseria meningitidis, Serogroup C; Phenotype; Polymorphism, Restriction Fragment Length; Rifampin; Serotyping; Uruguay

Up-to-date information regarding the antibiotic susceptibility of Neisseria meningitidis strains from African countries is highly limited. Our aim was to comprehensively describe the antibiotic susceptibilities of a selection of N. meningitidis isolates recovered between 2000 and 2006 from 18 African countries, mainly those within the meningitis belt. Susceptibilities to 11 antibiotics were determined using Etest for 137 N. meningitidis isolates (stringently selected from 693 available isolates). The isolates were also characterized by serogrouping, multilocus sequence typing, genosubtyping, and penA allele identification. All N. meningitidis isolates were susceptible to ceftriaxone, chloramphenicol, and ciprofloxacin. No isolate produced beta-lactamase. Only three isolates (2%) displayed reduced susceptibility to penicillin G. The two isolates with the highest penicillin G MICs were the only isolates showing reduced susceptibility to ampicillin and cefuroxime. One of these isolates was also resistant to penicillin V. One percent of isolates displayed reduced susceptibility to rifampin, while 52% of the isolates were resistant to tetracycline, 74% were resistant to erythromycin, and 94% were resistant to sulfadiazine. The MICs of rifampin and tetracycline seemed to be associated with the serogroup of the isolates. In total, 18 sequence types (STs), 10 genosubtypes, and 8 different penA alleles were identified; the most common were ST-7, P1.20,9,35-1, and penA4, respectively. A high level of correlation was found between ST, genosubtype, and penA allele. In conclusion, N. meningitidis isolates from the African meningitis belt remain highly susceptible to the antibiotics used. Regarding beta-lactam antibiotics, rare isolates showed a reduced susceptibility to penicillins, but the expanded-spectrum cephalosporins are not affected at present.

Topics: Africa; Genotype; Humans; Meningitis, Meningococcal; Microbial Sensitivity Tests; Neisseria meningitidis; Phenotype; Sequence Analysis, DNA; Time Factors

Topics: Adult; Anti-Bacterial Agents; Drug Resistance, Microbial; Humans; Male; Meningitis, Meningococcal; Neisseria meningitidis; Rifampin; Treatment Failure

Topics: Animals; Anti-Bacterial Agents; Base Sequence; Biological Assay; DNA, Bacterial; Drug Resistance, Bacterial; Female; Gene Amplification; Humans; Meningitis, Meningococcal; Mice; Mice, Inbred BALB C; Microbial Sensitivity Tests; Mutation; Neisseria meningitidis; Rifampin; Virulence

This study was planned to compare the efficacy of ceftriaxone+vancomycin with ceftriaxone+rifampicin in a rabbit model of penicillin and cephalosporin-resistant Streptococcus pneumoniae meningitis. Meningitis was induced by intracisternal inoculation of S. pneumoniae. After 18 h of incubation, Group 1 was given saline solution (control group), whilst Groups 2 and 3 were given ceftriaxone+vancomycin and ceftriaxone+rifampicin, respectively. Cerebrospinal fluid bacterial concentrations were measured at 0, 2, 12, 14 and 24 h after therapy was initiated. In the control group, bacterial growth was present at all time points, whereas no growth was observed in either the ceftriaxone+vancomycin group or the ceftriaxone+rifampicin group after 2 h of therapy. Ceftriaxone+rifampicin was found to be as effective as ceftriaxone+vancomycin in the treatment of penicillin-resistant S. pneumoniae meningitis in experimental rabbit model.

Topics: Animals; Anti-Bacterial Agents; Ceftriaxone; Cephalosporin Resistance; Cerebrospinal Fluid; Disease Models, Animal; Drug Resistance, Bacterial; Drug Therapy, Combination; Meningitis, Meningococcal; Penicillin Resistance; Rabbits; Rifampin; Streptococcus pneumoniae; Vancomycin

Topics: Antibiotics, Antitubercular; Child, Preschool; Family Health; Female; Humans; Infant; Male; Meningitis, Meningococcal; Rifampin

Topics: Alopecia Areata; Child; Female; Humans; Meningitis, Meningococcal; Rifampin

Endophthalmitis is a well-recognized, frequently devastating ophthalmic disease. The colonization of the eye and the subsequent development of endophthalmitis may be exogenous (including postsurgical and post-traumatic infections) or it may be of endogenous origin, representing a metastasis from a focus of infection elsewhere in the body associated with bacteremia (such as meningitis or cellulitis).

Topics: Ceftriaxone; Cerebrospinal Fluid; Chloramphenicol; Dexamethasone; Drug Therapy, Combination; Female; Humans; Infant; Meningitis, Meningococcal; Neisseria meningitidis; Panophthalmitis; Rifampin

Topics: Adolescent; Anti-Infective Agents; Antibiotic Prophylaxis; Antibiotics, Antitubercular; Ciprofloxacin; Disease Transmission, Infectious; Drug Resistance, Bacterial; Female; Humans; Meningitis, Meningococcal; Microbial Sensitivity Tests; Neisseria meningitidis; Rifampin

The objective of this study was to describe the epidemiology and public health response to an apparent cluster of Neisseria meningitidis serogroup C infection in university students in a residential college. A conventional epidemiological approach was taken, supported by routine and novel diagnostic techniques. Over the two days of 21-22 August 1997, three cases of suspected meningococcal infection were notified from a residential college complex at a university campus in the Sydney metropolitan area. Neisseria meningitidis was grown from throat swabs of all three cases, and was isolated from the blood of one case only. All three isolates were typed as C:2a:P1.5,2. Seroconversion was demonstrated by a novel method in the three cases. Rifampicin was given to all identified contacts. Forty-seven days after the index case, a 19 year old female living in the same complex was diagnosed with bacterial meningitis, and identified contacts given rifampicin. When this isolate was found to be group C, it was decided to vaccinate residents of the college complex. Genotyping and serotyping (C:2a:P1.5) later revealed the fourth isolate to be distinct from isolates from Cases 1-3. In conclusion the authors note that Australia's increasing capacity to type meningococcal strains is essential to understanding the epidemiology of this disease. Furthermore, typing information is of critical importance when decisions are made regarding mass vaccination. As early antibiotic treatment may inhibit isolation of the organism, development of novel approaches to diagnosis and typing should be supported.

Topics: Adolescent; Adult; Cluster Analysis; Disease Outbreaks; Female; Humans; Incidence; Male; Meningitis, Meningococcal; Neisseria meningitidis; Polysaccharides, Bacterial; Rifampin; Risk Factors; Serologic Tests; Severity of Illness Index; Universities; Wales

Topics: Antibiotics, Antitubercular; Humans; Infectious Disease Transmission, Patient-to-Professional; Meningitis, Meningococcal; Nursing Staff; Occupational Diseases; Rifampin

The mother of an eight-month-old child with meningitis presented with petechiae on her trunk and lower extremities, fever, and oligoarthritis. Although pathogens were never revealed by Gram stain nor cultured from the aspirated joint fluid, the diagnosis was primary meningococcal arthritis. This diagnosis was based on the simultaneous occurrence of Neisseria meningitidis group B infection in her son and the clinical presentation.

Topics: Antibiotics, Antitubercular; Arthritis, Infectious; Ceftriaxone; Cephalosporins; Female; Follow-Up Studies; Humans; Infant; Male; Meningitis, Meningococcal; Rifampin; Sepsis

Topics: Adolescent; Adult; Antibiotic Prophylaxis; Ceftriaxone; Child; Child, Preschool; Dose-Response Relationship, Drug; Drug Administration Schedule; Humans; Infant; Meningitis, Meningococcal; Rifampin

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Burundi; Child; Chloramphenicol; Disease Outbreaks; Gentamicins; Humans; Lactams; Meningitis, Meningococcal; Neisseria meningitidis; Rifampin

Topics: Adolescent; Adult; Child; Child, Preschool; Humans; Meningitis, Meningococcal; Penicillins; Rifampin; Risk Factors

An outbreak of 12 cases of meningitis, 11 caused by Neisseria meningitidis serogroup C, occurred at Doomadgee from September, 1990, to April, 1991. The incidence of meningitis was 17.55/10(3) person-years. Only children aged 1-10 years were affected. In October, 1990, or shortly thereafter, 473/509 children aged between 1 and 15 years inclusive had one dose of Mencevax AC. From the time of vaccination until April, 1991, a further eight cases occurred, six in vaccinated children. Vaccine efficacy in 1-15 year olds was calculated as 77%. Despite this, in April, 1991, the prevalence of antibody to group C polysaccharide in vaccinated children (78%) was not significantly different from that in unvaccinated children and adults. 46 nonresponders were revaccinated, and, in February, 1992, 78% had antibodies to group C polysaccharide. In April, 1991, an estimated 3.0% of the population had group C organisms, carriage being directly related to household crowding. In June, 1991, 2 months after mass prophylaxis with rifampicin, none of these individuals were carriers. In October, 1991, the carriage rate of group C organisms was 0.64%. There have been no further cases caused by the epidemic strain. Although uncrowded housing is a basic need, mass chemoprophylaxis and two doses of vaccine for children should be used in similar outbreaks.

Topics: Adolescent; Australia; Bacterial Vaccines; Carrier State; Child; Child, Preschool; Disease Outbreaks; Female; Humans; Immunization, Secondary; Incidence; Infant; Male; Meningitis, Meningococcal; Meningococcal Vaccines; Native Hawaiian or Other Pacific Islander; Neisseria meningitidis; Polysaccharides, Bacterial; Rifampin

Topics: Adolescent; Bacterial Vaccines; Child; Child, Preschool; Disease Outbreaks; Housing; Humans; Infant; Meningitis, Meningococcal; Nasopharynx; Native Hawaiian or Other Pacific Islander; Neisseria meningitidis; Queensland; Rifampin; Vaccination

Three cases of recrudescence and relapse of Neisseria meningitidis group B meningitis and septicaemia are reported. The recrudescence and relapses could not be explained by infectious foci, increased bacterial penicillin resistance or immunological defects. As a supplement to antibiotic treatment, all three patients received corticosteroids for the initial 2 days of treatment, and this may have contributed to the unusual course of the disease in our patient.

Topics: Administration, Oral; Anti-Bacterial Agents; Bacteremia; Child, Preschool; Chloramphenicol; Ciprofloxacin; Female; Follow-Up Studies; Humans; Hydrocortisone; Infant; Injections, Intravenous; Male; Meningitis, Meningococcal; Methylprednisolone; Penicillin G; Penicillin V; Recurrence; Rifampin; Time Factors

There is little evidence supporting the efficacy of prophylactic antibiotics in preventing secondary cases of bacterial meningitis, and recent guidance extended the use of prophylactic antibiotics amongst children who attend pre-school groups.. We examined the volume of rifampicin prescribed, and that recommended to contacts of cases of meningococcal and Hib meningitis in Somerset over a three-year period using case note records of the Consultant for Communicable Disease Control (CCDC) and PACT data.. There was evidence of excessive prescribing over and above that recommended by the CCDC.. Excessive prescribing increases the chance of serious drug side effects and the development of antibiotic resistance. It is suggested that both meningitis contacts and information about early symptoms of meningitis, as well as an explanation of the rationale behind the prescribing of antibiotic prophylaxis to contacts. This may reduce the likelihood of unnecessary prescribing and subsequent complications.

Topics: Adult; Antibiotic Prophylaxis; Child; Child Day Care Centers; Child, Preschool; Contact Tracing; Cross Infection; Dose-Response Relationship, Drug; Drug Administration Schedule; Drug Utilization; England; Family Practice; Female; Health Services Misuse; Humans; Infant; Male; Meningitis, Bacterial; Meningitis, Haemophilus; Meningitis, Meningococcal; Rifampin; Risk; Treatment Outcome

A case of sepsis and meningitis caused by Neisseria meningitidis with relative resistance to penicillin occurred in North Carolina in August 1992. This isolate was relatively resistant due to decreased affinity of its penicillin-binding protein 2 for penicillin. Such isolates have been reported in Spain, elsewhere in Europe, in South Africa, and in Canada, but invasive disease caused by meningococcal isolates relatively resistant to penicillin was not recognized in the United States before a preliminary report of this case in October 1992. The Centers for Disease Control and Prevention recently retrospectively identified 3 additional cases from 1991. A fifth case occurred in Kentucky in 1993. Surveillance studies of penicillin susceptibility of N. meningitidis isolates suggest such meningococci have existed sporadically in the past. Increases in prevalence and magnitude of penicillin resistance among strains of N. meningitidis would require reconsideration of current clinical practice with regard to treatment of meningococcal disease.

Topics: Amoxicillin; Bacteremia; Bacterial Proteins; Carrier Proteins; Ceftriaxone; Drug Therapy, Combination; Female; Hexosyltransferases; Humans; Infant; Meningitis, Meningococcal; Meningococcal Infections; Multienzyme Complexes; Muramoylpentapeptide Carboxypeptidase; Neisseria meningitidis; North Carolina; Otitis Media; Penicillin G; Penicillin Resistance; Penicillin-Binding Proteins; Peptidyl Transferases; Rifampin

Topics: Age Factors; Child; Child Day Care Centers; Child, Preschool; Haemophilus Infections; Haemophilus influenzae; Humans; Infant; Meningitis, Meningococcal; Recurrence; Rifampin

Topics: Adult; Bacteria, Aerobic; Drug Resistance, Microbial; Humans; Meningitis, Meningococcal; Oropharynx; Rifampin

To describe an outbreak of meningococcal meningitis and the impact of rifampicin chemoprophylaxis on secondary attack rates among Aboriginal people in central Australia.. Prospective study of patients admitted to hospital between September 1987 and May 1991.. The Alice Springs Health Region of the Northern Territory and the Anangu Pitjantjatjara Lands of South Australia, covering a population of 13,228 Aboriginal people.. Patients admitted to the Alice Springs Hospital with clinical signs or autopsy findings of meningococcal disease. Rifampicin chemoprophylaxis was given to close contacts of all cases. Mencevax AC vaccine was offered to children aged 1 to 15 years in the Region.. Blood or cerebrospinal fluid (CSF) with Neisseria meningitidis, or a positive result of latex agglutination testing on CSF. Positive isolates were serogrouped.. Seventy-seven cases of meningococcal disease were diagnosed in Aboriginal people over four years compared with one to two cases per year previously; of these, 60 were definite, 7 probable and 10 suspected cases. Seventy-six subjects had meningitis, of whom one also had the clinical features of meningococcal septicaemia; one other subject had positive blood cultures with a mild febrile illness without features of meningitis. The annual attack rate of meningococcal disease in the Aboriginal population was 1.6/1000. The relative risk for secondary cases was estimated to be between 0.3 (95% confidence interval [CI], 0.09-0.92) and 0.5 (95% CI, 0.15-1.53). The annual attack rate in the non-Aboriginal population was 0.04/1000.. The epidemic closely resembled those in sub-Saharan Africa, and in socioeconomically marginalised groups in developed countries. The relative risk for secondary cases was lower than generally reported, and was attributed to chemoprophylaxis for close contacts and the mass vaccination program for children. Until there are major improvements in living conditions, infectious diseases such as those transmitted by airborne droplets will continue to occur in Aboriginal communities.

Topics: Adolescent; Adult; Bacterial Vaccines; Child; Child, Preschool; Disease Outbreaks; Female; Humans; Infant; Male; Meningitis, Meningococcal; Meningococcal Vaccines; Neisseria meningitidis; Polysaccharides, Bacterial; Prospective Studies; Rifampin; Risk Factors; Seasons; Serologic Tests; South Australia; Survival Rate

Topics: Adult; Child; Disease Outbreaks; Drug Resistance, Microbial; Humans; Israel; Male; Meningitis, Meningococcal; Neisseria meningitidis; Rifampin

Topics: Child, Preschool; Humans; Infant; Meningitis, Meningococcal; Rifampin

Since 1987 we have analysed throat samples from 1,086 healthy contacts of 32 patients with meningococcal disease. The disease-causing strain was found in contacts of 17 out of the 32 patients. 161 (18%) of the contacts carried meningococci, and 30 (3%) of them were carriers of the disease-causing strain as determined by DNA fingerprinting. The carrier strain was eradicated in 29 of these 30 contacts by treatment with rifampicin. No secondary case of meningococcal disease was observed. During the four-year period 1984-87, there were 39 confirmed cases of meningococcal disease, including 12 verified and four suspected secondary cases of meningococcal disease. Therefore identification and eradication of the disease-causing strain seems to prevent secondary cases. A change in the Norwegian recommendations for preventing secondary cases of meningococcal disease should be discussed.

Topics: Adolescent; Adult; Aged; Carrier State; Child; Child, Preschool; Contact Tracing; Female; Humans; Infant; Male; Meningitis, Meningococcal; Middle Aged; Norway; Pharynx; Rifampin

To assess the secondary attack rate (SAR) of meningococcal disease among the household contacts of primary patients and to describe the use of chemoprophylaxis in the Netherlands.. Descriptive, nation-wide survey.. Information was collected of patients with meningococcal disease, reported between April 1st, 1989 and April 30th, 1990, and their household contacts. A household contact suffering from meningococcal disease between 24 hours and 1 month after hospital admission of the primary patient, was considered to be a secondary case. Chemoprophylaxis was considered appropriate if rifampicin or minocycline had been prescribed to all household contacts within a maximum of one day after admission of the primary patient.. There were 5 secondary cases (SAR: 0.3%). Chemoprophylaxis was prescribed to 627 of 1130 household contacts (55%). Of those the prophylaxis was considered appropriate in 46%. 2 secondary cases were not given any prophylaxis, 2 received penicillin and 1 rifampicin. Of the primary patients, 6% were given prophylaxis during their hospital stay. All meningococci, isolated from pairs of secondary and primary patients, were rifampicin sensitive.. The SAR of meningococcal disease in the Netherlands is similar to that in other countries. Although prescription of chemoprophylaxis is not recommended by the government, it is prescribed to 55% of the household contacts, and in almost half of these instances it was considered to be appropriate. Chemoprophylaxis is rarely prescribed to primary patients. Recommendations concerning chemoprophylaxis in the Netherlands are in need of reappraisal. Based on the results from this study and the literature, the prescription of chemoprophylaxis to all household contacts of a patient with meningococcal disease, and to the index patient, is recommended.

Topics: Adult; Child; Family; Female; Humans; Male; Meningitis, Meningococcal; Minocycline; Rifampin; Time Factors

Topics: Adult; Ceftriaxone; Child; Gonorrhea; Humans; Meningitis, Meningococcal; Rifampin; Spectinomycin

Topics: Female; Humans; Meningitis, Meningococcal; Middle Aged; Purpura, Thrombocytopenic; Rifampin

In Wales, in 1988, 119 patients with meningococcal disease were identified, so giving a crude annual incidence of 4.2 patients per 100,000 population. The combined classical clinical features of fever, vomiting, neck stiffness, headache and purpuric rash were identified in only 9% of patients. Fever and vomiting were the commonest symptoms, both being present in 60% of patients. A rash was noted in 77% of patients but neck stiffness in only 39%. Rash was more common in children, headache and photophobia in adults. A total of 13 patients died, the fatality rare increasing with age from 3% in infants to 20% in older teenagers and adults. Only 15% of 75 patients admitted to hospital by general practitioners were known to have received intravenous or intramuscular penicillin before admission as recommended by the Chief Medical Officers of the Health Departments in the U.K. Only 24% of patients received rifampicin to clear nasopharyngeal carriage before or at discharge from hospital. Altogether, 375 household contacts of patients were identified. At least 84% of them received chemoprophylaxis.

Topics: Acute Disease; Adolescent; Adult; Age Factors; Child; Child, Preschool; Contact Tracing; Female; Humans; Infant; Infant, Newborn; Male; Meningitis, Meningococcal; Middle Aged; Penicillins; Public Health Administration; Rifampin; Treatment Outcome; Wales

Epidemiological features of an outbreak of group B:15:P1.16 meningococcal disease (MD) in Frederiksborg county, Denmark, 1987-9, were investigated. The study comprised 149 cases notified during the outbreak and the two preceding years; 115 were confirmed by the isolation of Neisseria meningitidis. In 1989 the incidence had increased to 14.1 per 100,000 population. Among group B strains, B:15:P1.16 accounted for 80% (77/97). The overall mortality rate was 10% (15/149). Regarding cases due to group B:15:P1.16 strains a significant time-space clustering, which exclusively occurred within the 10-19 years age group, was demonstrated. The link between cases within clusters was indirect or unknown, except for ten patients with contact to one particular school. The prophylactic measures used included administration of rifampicin to household contacts. During the outbreak the proportion of secondary cases was high (6-15%). All secondary cases occurred outside the household indicating that the household had been protected.

Topics: Adolescent; Adult; Age Factors; Bacteremia; Child; Child, Preschool; Cluster Analysis; Denmark; Disease Outbreaks; Female; Humans; Infant; Male; Meningitis, Meningococcal; Meningococcal Infections; Neisseria meningitidis; Prevalence; Rifampin; Seasons; Serotyping; Sex Factors; Suburban Population

Topics: Adolescent; Carrier State; Child; Female; Humans; Meningitis, Meningococcal; Rifampin; Time Factors

Since February 5th 1990, the prevention of secondary cases of cerebrospinal meningitis (CSM) in France has been obtained by the use of rifampin. Following the detection of a case of N. meningitidis of antigenic formula B:NT:P1.15,16 in a military population, 89 contacts subjects received 600 mg rifampin twice a day during 2 days. Meningococcal carriage rate was investigated by nasopharyngeal swab sampling of the 89 subjects and 62 non-contact controls from the same community. Twenty-three days after the initial case of meningitis, carriage rate was 5.6% for treated subjects and 37.1 for controls. Sero-grouping, serotyping and subtyping failed to detect the initial virulent strain; it demonstrated the heterogeneity of circulating strains. Since rifampin-resistant mutants may occur, two strains in the treated group, it is essential that chemoprophylaxis in a community be limited strictly to the contact subjects.

Topics: Drug Resistance, Microbial; France; Humans; Male; Meningitis, Meningococcal; Military Personnel; Nasopharynx; Neisseria meningitidis; Reference Values; Rifampin; Serotyping

In Norway, the use of chemoprophylaxis after cases of meningococcal disease is not recommended. Instead, household members less than 15 years are treated with penicillin for 7 days. Failures of this treatment have been reported. We therefore used DNA fingerprinting to identify the disease-causing strain in healthy contacts combined with selective rifampicin prophylaxis to these carriers to prevent secondary cases. During a 2-year period (1987-89) there were 13 cases of meningococcal disease in the County of Telemark (165000 inhabitants). 65 (14.7%) out of 441 contacts to these 13 patients harbored meningococci in their throat; 16 (3.6%) carried the disease-causing strain. Only 1 carrier fulfilled the criteria for being treated with penicillin; 8 were adults and the remaining 7 were not household members. No secondary cases of meningococcal disease occurred during the study period or the following 12 months. During the 4-year period (1984-87) preceding the study period there were 39 cases of meningococcal disease in Telemark; 7 of them were index cases for 12 bacteriologically verified and 4 clinically suspected secondary cases of meningococcal disease. We conclude that selective prophylaxis with rifampicin seems to be more efficient that penicillin treatment of household members less than 15 to prevent secondary cases of meningococcal disease.

Topics: Adolescent; Adult; Aged; Bacteremia; Carrier State; Child; Child, Preschool; DNA Fingerprinting; DNA, Bacterial; Female; Humans; Infant; Male; Meningitis, Meningococcal; Meningococcal Infections; Middle Aged; Neisseria meningitidis; Norway; Penicillins; Pharynx; Rifampin; Serotyping

Intimate contacts of a patient with meningococcal disease are at greater risk of disease than the general population and are offered chemoprophylaxis in order to prevent secondary cases. School contact is not considered a risk factor unless a further case develops. Bacteriological sampling of contacts to identify potential sources of infection is not considered warranted. We have questioned these approaches and investigated the contacts of a 9-year-old child with meningitis caused by sulphonamide-sensitive Neisseria meningitidis group C. Household carriers were not identified but 7/34 classmates were carrying the index strain suggesting that transmission was occurring within this population. The current recommendations for prophylaxis are based on information gathered in socioepidemiological settings, and involving strains which differ from those now prevalent. Such extrapolations may not be justified and further microbiological studies seem warranted to re-examine meningococcal transmission and prophylaxis usage in school children.

Topics: Carrier State; Child; Contact Tracing; Disease Outbreaks; Enzyme-Linked Immunosorbent Assay; Female; Humans; Latex Fixation Tests; Meningitis, Meningococcal; Neisseria meningitidis; Oropharynx; Rifampin; Risk Factors; Schools; United Kingdom

Chemoprophylaxis of meningitis caused by Neisseria meningitidis and Haemophilus influenzae may be determined by the epidemiology of transmission, the antibiotic susceptibility patterns of the organisms, and the usage of vaccines. A review of transmission in England distinguishes differences in sporadic and cluster meningococcal infections. Because of resistance to sulphadiazine, rifampicin and ciprofloxacin are prophylactic agents of choice. Vaccination can be a useful adjunct to antibiotic prophylaxis. Prophylaxis for meningitis due to H. influenzae type b can be provided by rifampicin and vaccination can also be an adjunct to antibiotic prophylaxis.

Topics: Ciprofloxacin; Humans; Meningitis, Haemophilus; Meningitis, Meningococcal; Rifampin; Vaccination

Topics: Adolescent; Adult; Contact Tracing; Female; Humans; Male; Meningitis, Meningococcal; Middle Aged; Quebec; Rifampin; Social Environment

Following the occurrence of a case of meningococcal disease in a kibbutz, extensive preventive measures were instituted, consisting of alternate courses of rifampicin (10 mg/kg for 2 consecutive days) and ceftriaxone (single IM injection of 125 mg). Throughout the observation period Neisseria meningitidis was absent from oropharyngeal secretions of all those treated, but was found in those of an untreated control group. The alternate use of rifampicin and ceftriaxone should be considered for the long-term prevention of the occurrence of oropharyngeal carriers of Neisseria meningitidis.

Topics: Carrier State; Ceftriaxone; Drug Administration Schedule; Humans; Meningitis, Meningococcal; Meningococcal Infections; Neisseria meningitidis; Oropharynx; Rifampin

We described two cases of meningococcal infection in a family. Both were detected in a period of seven months. We studied the epidemiological markers of strains isolated from cases and close contacts of the second case. The isolate of first case is identical to the rest of strains studied and we suggest the possibility of persistence and transmission of infection of the index case to the close contacts and the second case. In this paper it is discussed the application of control measures to eradicate the meningococcus from the nasopharynx of patients after the illness, principally in workers with close contacts with populations at risk and in epidemic periods.

Topics: Carrier State; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Male; Meningitis, Meningococcal; Middle Aged; Nasopharynx; Neisseria meningitidis; Rifampin

Topics: Bacterial Vaccines; Carrier State; Drug Resistance, Microbial; Humans; Meningitis, Meningococcal; Meningococcal Vaccines; Penicillins; Rifampin

On the Faroe Islands (45,000 inhabitants), a total of 203 cases of meningococcal disease (MD) were recorded during the period 1978-1985. The peak incidence was 95/100,000 in 1981. MD mainly attacked children, 30% were below two years and 75% were below 11 years of age. The lethality rate was 5.4% (11 deaths). In 1981, rifampicin was introduced as a prophylactic treatment against secondary cases and at the same time, a decrease in incidence occurred. The decrease was more pronounced in the part of the country where the number of prescribed prophylactic doses per case of MD was greatest. These observations indicate that the introduction of rifampicin may have modified the course of the epidemic. None of the MD-patients had received prophylactic treatment with rifampicin. Of 132 examined, one patient with complement deficiency was identified, indicating that complement deficiencies were not a major risk factor in the epidemic of MD on the Faroe Islands.

Topics: Adolescent; Adult; Aged; Child; Child, Preschool; Denmark; Female; Humans; Male; Meningitis, Meningococcal; Meningococcal Infections; Middle Aged; Rifampin

Topics: Family Practice; Humans; Infant; Infant, Newborn; Meningitis, Meningococcal; Penicillins; Rifampin; Sepsis; United Kingdom

We have reported the epidemiologic investigation and subsequent control measures precipitated by the occurrence of two temporally related cases of invasive meningococcal disease in a single day-care center classroom. A review of the literature indicates that day-care center contacts of patients with invasive meningococcal disease are at increased risk for secondary spread of infection. Our experience emphasizes the importance of reporting cases to the local health department, implementing rifampin prophylaxis for appropriate contacts, and considering immunization in select circumstances. Rifampin is indicated for all cases of meningococcal disease as well.

Topics: Bacterial Vaccines; Child Day Care Centers; Child, Preschool; Female; Humans; Male; Meningitis, Meningococcal; Meningococcal Vaccines; Neisseria meningitidis; Rifampin

Topics: Attitude of Health Personnel; Child; Humans; Legislation, Drug; Meningitis, Haemophilus; Meningitis, Meningococcal; Rifampin; United Kingdom

Topics: Adolescent; Female; Humans; Meningitis, Meningococcal; Microbial Sensitivity Tests; Neisseria meningitidis; Penicillin Resistance; Rifampin

In August 1987, an outbreak of group A meningococcal meningitis occurred during the annual pilgrimage to Mecca, Saudi Arabia, resulting in an attack rate among American pilgrims of 640 per 100,000. To determine risk factors for carriage, throat cultures were taken from passengers arriving on four consecutive flights from Saudi Arabia to the United States. Pilgrims were more likely to be group A meningococcal carriers than were nonpilgrims (relative risk, 11.1; 95% confidence interval, 3.7 to 33.1). Smoking, crowding, and meningococcal vaccination were not significantly associated with group A carriage. Pilgrims complaining of recent fever or sore throat, however, were more likely to be group A carriers, consistent with previous reports linking carriage and disease to preceding viral infections. Serogrouping of invasive meningococcal isolates can be used to monitor for indigenous transmission of this unusual strain in the United States, and we recommend routine vaccination of pilgrims to prevent future outbreaks of meningococcal disease.

Topics: Adolescent; Adult; Aged; Bacterial Vaccines; Carrier State; Child, Preschool; Disease Outbreaks; Female; Humans; Male; Meningitis, Meningococcal; Meningococcal Vaccines; Middle Aged; Respiratory Tract Infections; Rifampin; Risk Factors; Saudi Arabia; Seasons; Travel; United States

Topics: Adolescent; Ciprofloxacin; Disease Outbreaks; Drug Resistance, Microbial; Humans; Male; Meningitis, Meningococcal; Military Personnel; Naval Medicine; Rifampin; United Kingdom

Topics: Anti-Bacterial Agents; Bacterial Infections; Child; Humans; Meningitis, Haemophilus; Meningitis, Meningococcal; Premedication; Rifampin

A fatal meningitis due to a spiramycin-sensitive group B Neisseria meningitidis occurred 13 days after interruption of a prophylactic antimicrobial therapy with spiramycin. The efficacy of recommended antimicrobial preventive treatment is discussed with regard to this case, other published cases and to the known partial and short term eradication of the naso-pharyngeal carriage of Neisseria meningitidis.

Topics: Adult; Female; Humans; Leucomycins; Meningitis, Meningococcal; Minocycline; Rifampin

Topics: Child, Preschool; Humans; Injections, Intravenous; Male; Meningitis, Meningococcal; Neisseria meningitidis; Penicillin Resistance; Penicillins; Rifampin; Sulfadiazine; Time Factors

Topics: Bacterial Vaccines; Carrier State; Drug Resistance, Microbial; Humans; Meningitis, Meningococcal; Meningococcal Vaccines; Minocycline; Neisseria meningitidis; Nigeria; Rifampin; Sulfadiazine; United States

An epidemic of meningococcal disease after an influenza outbreak in a community of 49 boys (14-18 years) and 8 adults in a boarding-school is reported. The first patient died with all symptoms of the Waterhouse-Friderichsen syndrome. Several hours later, two other boys developed severe septicemia with meningitis and meningitis respectively. N. meningitidis group B susceptible to penicillin and rifampin was isolated. Within the next 8 hours, chemoprophylaxis with rifampin (600 mg twice daily) was started and maintained for 4 days for the whole community. Throat cultures had not been obtained before prophylaxis. Ten other symptomatic boys were admitted to the hospital and treated by penicillin infusion. The results of blood and cerebrospinal fluid cultures were negative, and treatment was therefore discontinued. Five days after the death of the first boy, another boy died with full-blown Waterhouse-Friderichsen syndrome while on chemoprophylaxis. The neisseriae isolated from this patient were rifampin-resistant. Serological investigations in all patients admitted to hospital revealed the existence of concomitant epidemic infection with influenza A and B in this school. We assume that the viral infection made way for the outbreak of the meningococcal disease and for the high rate of secondary meningococcal infection. Chemoprophylaxis with rifampin should not be continued for longer than 2 to 3 days, otherwise the risk of occurrence of rifampin resistant strains of N. meningitidis increases. Hitherto such strains have rarely been isolated in clinically manifest disease.

Topics: Adolescent; Adult; Disease Outbreaks; Humans; Influenza, Human; Male; Meningitis, Meningococcal; Meningococcal Infections; Neisseria meningitidis; Penicillin Resistance; Penicillins; Rifampin; Schools; Switzerland; Waterhouse-Friderichsen Syndrome

Topics: Child; Disease Outbreaks; Disease Susceptibility; Drug Resistance, Microbial; Humans; Meningitis, Meningococcal; Neisseria meningitidis; Rifampin; Risk; Socioeconomic Factors; Spain

Close contact of patients with bacterial meningitis that is caused by either Haemophilus influenzae type b or Neisseria meningitidis are at an increased risk of developing invasive infections with these bacteria. Chemoprophylaxis with rifampin and immunoprophylaxis with vaccines may prevent some secondary infections.

Topics: Antibody Formation; Child; Child, Preschool; Humans; Immunization; Infant; Infant, Newborn; Meningitis, Haemophilus; Meningitis, Meningococcal; Minocycline; Rifampin; Risk

Topics: Chlamydia Infections; Drug Resistance, Microbial; Drug Therapy, Combination; Haemophilus Infections; Humans; Meningitis, Meningococcal; Rifampin; Staphylococcal Infections; Trimethoprim

Close contacts of index patients with Neisseria meningitidis or Haemophilus influenzae type b meningitis show higher nasopharyngeal carriage rates and are at an increased risk of contracting the disease. The key issue in the management of such contacts remains close and careful surveillance, because prophylaxis will never result in the absolute prevention of secondary cases. Adequate chemoprophylaxis with rifampin eradicates nasopharyngeal colonization in more than 90% and may prevent both co-primary and secondary diseases. Routine chemoprophylaxis for close contacts of systemic meningococcal diseases is recommended. However, there are several factors inherent in rifampin prophylaxis for the prevention of H. influenzae type b meningitis which exclude its use as a routine measure.

Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Infant, Newborn; Meningitis, Haemophilus; Meningitis, Meningococcal; Rifampin

Community chemoprophylaxis with a regimen of sequential minocycline/rifampin (adults) or rifampin alone (children [less than 12 years of age]) was undertaken in a remote Arctic community one year after an outbreak of meningitis due to Neisseria meningitidis serogroup B. Nasopharyngeal carriage rates of N. meningitidis before prophylaxis were 32.4% in Inuit (Eskimos) and 6% in Caucasians, with maximal carriage (44.8%) in adolescents. Serogroup B accounted for 63.9% of all isolates before prophylaxis. One week after prophylaxis, the nasopharyngeal carriage rates were 0.8% in Inuit who had received prophylaxis and 33.3% in those who had not received prophylaxis (P less than 0.005). This reduction persisted at nine weeks after prophylaxis, when carriage rates were 1.2% in those who had received prophylaxis and 22.6% in individuals who had not received prophylaxis. Of the strains obtained before prophylaxis, 7.8% were sulfadiazine-resistant, whereas 35% of all isolates obtained from prophylaxis were sulfadiazine-resistant. Rifampin- or minocycline-resistant strains were not identified either before or after prophylaxis.

Topics: Adolescent; Adult; Arctic Regions; Canada; Carrier State; Child; Child, Preschool; Female; Humans; Inuit; Meningitis, Meningococcal; Microbial Sensitivity Tests; Minocycline; Nasopharynx; Neisseria meningitidis; Patient Compliance; Population Surveillance; Pregnancy; Rifampin; Serotyping; Tetracyclines

Topics: Adolescent; Carrier State; Child; Child, Preschool; Female; Humans; Male; Meningitis, Meningococcal; Microbial Sensitivity Tests; Neisseria meningitidis; Rifampin

Satisfactory permeability of rifampicin through the hematoencephalic barrier was shown in experimental rabbit meningococcal meningitis and in treatment of patients with meningococcal meningitis. The antibiotic level and retention time in the liquor depended on the drug dose and acidity of gastric juice. The dose of 10 mg/kg bw administered at 8--10-hour intervals was the most optimal. The high therapeutic efficacy of rifampicin in treatment of patients with the generalized forms of meningococcal meningitis enables its recommendation for the use as a reserve drug. Rifampicin may be used alone when penicillin is intolerable or ineffective. It also may be used for additional treatment of the patients after penicillin therapy. Rifampicin in combination with penicillin may be used in treatment of purulent meningitis and meningoencephalitis of a dubious etiology.

Topics: Animals; Blood-Brain Barrier; Dose-Response Relationship, Drug; Drug Evaluation; Drug Evaluation, Preclinical; Humans; Kinetics; Meningitis, Meningococcal; Meningococcal Infections; Rabbits; Rifampin; Time Factors

Topics: Adolescent; Child; Child, Preschool; Humans; Infant; Meningitis, Haemophilus; Meningitis, Meningococcal; Rifampin; Sulfadiazine; Vaccination

An outbreak of three cases of meningococcal disease occurring in a family of 14 is presented. Three of the children, between the ages of 10 months to 10 years, were hospitalized. Two of them showed positive signs of meningitis, and one had evidence of bacteremia. Neisseria meningitidis was isolated from a blood sample of one patient and a CSF sample of another. The organism was also recovered from the nasopharyngeal secretion of four other adult members of the family. All three hospitalized children were treated with parenteral penicillin and responded well to therapy. The rest of the family was treated with oral rifampin, and subsequent cultures of the nasopharynx were negative.

Topics: Carrier State; Child; Disease Outbreaks; District of Columbia; Female; Humans; Infant; Male; Meningitis, Meningococcal; Penicillin G; Rifampin

Two couples of sibs presented with meningococcal meningitis. In both families, immediate preventive measures were not taken due to a negative cerebrospinal fluid (CSF) smear in the first case from Family A, and a negative CSF smear and culture in the first case from Family B. All the children were treated successfully. Our recommendations are: a) contacts of patients with pyogenic meningitis should have close clinical surveillance, and b) contacts of meningococcal infection should have nasopharyngeal cultures and should be given a prophylactic antibiotic such as rifampicin or minocycline.

Topics: Adolescent; Child, Preschool; Female; Humans; Infant; Male; Meningitis, Meningococcal; Minocycline; Rifampin

During an epidemic caused by sulfonamide-resistant group A Neisseria meningitidis (A SuR strain), rifampin (600 mg per day for four days) or minocycline (100 mg every 12 hr for five days) was administered as chemoprophylaxis to 1,540 unvaccinated recruits in the Finnish Armed Forces. Rates of carriage of all strains of N. meningitidis were initially reduced by 78% (from 60% to 13%) in the 389 men receiving rifampin and by 62% (from 70% to 26%) in the 1,151 men receiving minocycline but rose to approximately 30% in both groups four weeks after prophylaxis. The carriage of A SuR strains was similarly reduced. An individual follow-up of 636 trainees demonstrated a high rate of new infections. It is suggested that the long-term inefficiency of rifampin and minocycline is due to their inability to reduce the carriage rates enough to prevent further spread of infection after prophylaxis is descontinued. However, no new cases appeared among the men receiving the prophylaxis. Five strains highly resistant to rifampin were found after the use of rifampin (minimal inhibitory concentration, greater than or equal to 100 microgram/ml), but no minocycline-resistant strains were encountered. No unpleasant side effects were seen in subjects receiving either drug.

Topics: Finland; Humans; Male; Meningitis, Meningococcal; Military Medicine; Minocycline; Neisseria meningitidis; Rifampin; Sulfonamides; Tetracyclines

Topics: Child Day Care Centers; Child, Preschool; Female; Humans; Infant; Meningitis, Meningococcal; Patient Compliance; Rifampin; Risk

Topics: Humans; Male; Meningitis, Meningococcal; Meningococcal Infections; Middle Aged; Minocycline; Rifampin; Sepsis

Topics: Age Factors; Anti-Bacterial Agents; Carrier State; Child; Child, Preschool; Drug Therapy, Combination; Humans; Immunotherapy; Infant; Meningitis, Meningococcal; Meningococcal Infections; Minocycline; Neisseria meningitidis; Penicillin G; Penicillin Resistance; Rifampin; Sulfonamides; United States

Topics: Adult; Child; Humans; Infant; Meningitis, Meningococcal; Minocycline; Neisseria meningitidis; Rifampin

Topics: Adolescent; Carrier State; Child; Child, Preschool; Drug Resistance, Microbial; Female; Humans; Infant; Male; Meningitis, Meningococcal; Meningococcal Infections; Middle Aged; Nasopharynx; Neisseria meningitidis; Rifampin

Topics: Antibody Formation; Antigens, Bacterial; Bacterial Vaccines; Carrier State; Disease Outbreaks; Humans; Immunization; Immunotherapy; Meningitis, Meningococcal; Meningococcal Infections; Military Medicine; Minocycline; Neisseria meningitidis; Polysaccharides, Bacterial; Rifampin; Sepsis; Sulfadiazine; United States

Topics: Ampicillin; Chloramphenicol; Humans; Meningitis, Meningococcal; Microbial Sensitivity Tests; Neisseria meningitidis; Penicillin Resistance; Penicillins; Rifampin; Sulfadiazine; Tetracycline; Vaccination

Topics: Carrier State; Humans; Male; Meningitis, Meningococcal; Microbial Sensitivity Tests; Military Medicine; Nasopharynx; Neisseria meningitidis; Rifampin; Time Factors; United States

Topics: Humans; Meningitis, Meningococcal; Military Medicine; Rifampin