The New York State Department of Health issued an advisory Aug. 14 asking providers to discontinue use of ciprofloxacin as a post-exposure prophylaxis for close contacts of patients with meningococcal disease.
"Ciprofloxacin has been a first-line agent for invasive meningococcal disease post-exposure prophylaxis; however, due to increasing rates of ciprofloxacin resistance among invasive meningococcal disease cases, providers should discontinue use of ciprofloxacin as postexposure prophylaxis for close contacts of people with invasive meningococcal disease in New York state," the advisory said.
Rifampin or ceftriaxone should be prescribed for post-exposure prophylaxis instead, and azithromycin may be used as an alternative.
The change is due to increasing rates of resistance to the drug. Last year, four of 20 invasive meningococcal cases in the state of New York, but outside of New York City, were resistant to ciprofloxacin. Within the city, six of 35 cases were resistant.
"The number and proportion of patients diagnosed with ciprofloxacin-resistant invasive meningococcal disease in New York has approached the CDC-recommended threshold for discontinuing ciprofloxacin post-exposure prophylaxis in a local catchment area (at least two patients and 20% of patients) to prevent prophylaxis failure," the health department said.
Meningitis is a rare but serious disease that can cause pneumonia, bloodstream infections and brain swelling. Between 10% and 15% of cases in the U.S. are fatal, and providing antibiotic post-exposure prophylaxis to those who had close contact to patients with the disease is a major prevention strategy.