Backgrāounād
IMD is a rare and serious conditions. During the 5-year period from 2016-2020, 24 to 80 cases occurred yearly in California and 30 cases were reported in 2023.
Ciprofloxacin-resistant strains of Neisseria meningitidis have been increasing both nationally and internationally in recent years. In the last 12 months, there have been six reported cases IMD caused by cirpofloxacin-resistant strains in California. Resistance to ceftriaxone, the first-line antibiotic recommended for IMD
treatment, has not been detected.ā
CDC issued
public health guidance in May 2023 to discontinue use of ciprofloxacin for IMD PEP in any geographic area where two criteria are met over a rolling 12-month period:
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Two or more IMD cases caused by ciprofloxacin-resistant strains are reported, and
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The cases caused by ciprofloxacin-resistant strains make up at least 20% of all reported IMD cases.
The Bay Area/Sacramento region and the Southern California region met the threshold to discontinue ciprofloxacin IMD PEP earlier in 2024. Although the 20% threshold has not been met statewide, the California Department of Public Health (CDPH), in consultation with CDC, is now making a statewide IMD PEP change recommendation for California.
āRecommendations
āCiprofloxacin should no longer be used for IMD PEP in California. For IMD PEP, prescribe rifampin, ceftriaxone or azitrhomycin instead of ciprofloxacin. These recommendations should be followed until updated public health guidance is issued. Please see PEP dosing summary below and detailed guidance in the
CDPH Meningococcal Quicksheet (PDF).
No changes to empiric
treatment of IMD are recommended at this time. Providers are encouraged to request antimicrobial susceptibility testing (AST) of Neisseria meningitidis āisolates at their medical facility's laboratory to help guide clinical treatment, if such testing is available. The LHJ will assist with transfer of all meningococcal isolates to a public health lab for AST, but the results will not generally be available in time to guide treatment decisions.
Medical providers should continue to report all suspected and laboratory confirmed cases of IMD (generally bacteremia and/or meningitis due to Neisseria meningitidisā)
to their Local Health Department (LHD) immediately by telephoneā. The LHD will assist with identification of close contacts to the case and provide post-exposure prophylaxis (PEP) recommendations to contacts of the case.āāāāā
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10 mg/kg (maximum 600 mg), every 12 h, po | |
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āNot recommended for use in pregnant women.
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