New York State Department of Health Directs Providers to Discontinue Use of Ciprofloxacin to Prevent Meningococcal Disease Due to Increasing Antimicrobial Resistance

Health Advisory Notification Issued to Providers, Long Term Care Facilities, Clinical Laboratories and Local Health Departments

Rifampin and Ceftriaxone Remain First-Line Post-Exposure Prophylaxis Treatment Options

ALBANY, N.Y. (August 14, 2024)– The New York State Department of Health issued an advisory to health care providers today directing them to discontinue the use of the antibiotic ciprofloxacin to prevent disease in individuals who have had contact with patients diagnosed with or suspected to have invasive meningococcal disease in New York due to an increase of antimicrobial resistance. Providers should instead prescribe rifampin or ceftriaxone as post-exposure prophylaxis (PEP) instead.

"We are asking providers to discontinue the use of ciprofloxacin for individuals who have had close or prolonged contact with a person with meningococcal disease because we're finding evidence of increasing antibiotic resistance," State Health Commissioner Dr. James McDonald said. "Providers should instead use rifampin or ceftriaxone, as they remain a first-line treatment option. Importantly, the treatment recommendations have not changed—it's vital to begin antibiotic treatment promptly when invasive meningococcal disease is suspected."

Invasive meningococcal disease is a rare but severe infection that can present with swelling of the brain, blood stream infection, or other severe manifestations, like joint infections. In the United States, approximately 10-15 percent of cases are fatal. Providing antibiotics to close contacts of people with invasive meningococcal disease can prevent illness in those individuals. Approximately 30 cases of invasive meningococcal disease are reported in New York every year and cases have been increasing.

The New York State Health Department's Wadsworth Center and the New York City Public Health Laboratory routinely perform antimicrobial resistance testing on samples collected from patients recently diagnosed with invasive meningococcal disease. Over the past 18 months, this testing has showed an increase in ciprofloxacin-resistant strains of Neisseria meningitidis, the bacteria that causes invasive meningococcal disease, and led to this change in guidance for post-exposure prophylaxis. The change to the clinical recommendation is being driven by good public health investigation, sample collection and lab testing to ensure contacts of patients with invasive meningococcal disease who need PEP are getting the best possible treatment.

"We're communicating with providers to ensure people get the right medication to prevent them from getting this rare, but serious, disease," said Health Commissioner Dr. Ashwin Vasan. "This guidance is based on what we've learned through the hard work of teams across multiple disciplines, and we're proud to be working closely with our colleagues at the State Department of Health to prevent suffering and bad outcomes from invasive meningococcal disease."

The number and proportion of patients in New York who were diagnosed with ciprofloxacin-resistant invasive meningococcal disease has approached the U.S. Centers for Disease Control and Prevention (CDC)-recommended threshold to no longer recommend preventive ciprofloxacin in contacts of cases of invasive meningococcal disease.

PEP is recommended for close contacts of patients with invasive meningococcal disease, regardless of the contact's vaccination status. Rifampin or ceftriaxone remain first-line options for meningococcal disease PEP. Azithromycin may also be used as an alternative option. Providers may learn more by consulting the advisory here.

There are vaccines available to prevent invasive meningococcal disease. Vaccines are available for people 6 weeks of age and older and all children entering grades 7-12 must have the meningococcal vaccine. People with certain health problems or conditions, such as HIV or other immune problems, people that take certain medications, and people who have a heightened risk of infection should also be vaccinated. Anyone who is unsure of their vaccination status should reach out to a health care provider.

More information about meningococcal disease, including prevention, symptoms, and treatment can be found on the Department's dedicated website here.