• From 2019 to 2021, 29 cases of invasive meningococcal disease—caused by strains of bacteria resistant to the antibiotic ciprofloxacin—were reported in the US;

• These cases were spread out throughout the country, while some geographic regions showed clusters of the disease.

• One of the first-line medications that is advised for both treating patients and protecting their close contacts, who are more likely to contract the illness, is ciprofloxacin.

• There have not yet been any documented cases of prophylactic failure linked to ciprofloxacin resistance.

• However, the CDC states that there is little need to alter the antibiotic prophylaxis advice due to the significant risk of mortality associated with invasive meningococcal illness and the possibility of prophylactic failure.

• The CDC recommends other antibiotics be considered under the new guidelines if two or more cases of invasive meningococcal disease caused by ciprofloxacin-resistant strains are reported in a local catchment area over a rolling 12-month period, and if ciprofloxacin-resistant strains account for 20% or more of the cases of invasive meningococcal disease in that area.

• For prophylaxis, rifampin, ceftriaxone, and azithromycin are also suggested. 

• According to the CDC, local health agencies can adopt guidelines flexibly.

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