Reviewed by Dr. Michael Payne, MD; London Health Sciences Centre
Overall, resistance to post-exposure prophylaxis regimen antimicrobials was not detected for ceftriaxone and rifampin, and rarely detected for ciprofloxacin (<1%). Although penicillin resistance was low (<1%), there was a higher percentage of penicillin intermediate isolates identified (~25%). The clinical significance of increasing penicillin intermediate rates is uncertain but does reaffirm the need for antimicrobial susceptibility testing prior to use of penicillin for treatment of invasive meningococcal disease (IMD). As well there may be considerations for patients using complement inhibitors, such as eculizumab or ravulizumab, who are sometimes recommended to receive penicillin as a long-term chemoprophylaxis option for IMD. Data was obtained through CDC surveillance: Active Bacterial Core Surveillance (ABCs) from 2012 to 2016 and Enhanced Meningococcal Disease Surveillance (EMDS) from 2015-2016. All isolates were susceptible to 6 antibiotics (cefotaxime, ceftriaxone, meropenem, rifampin, minocycline, and azithromycin). Approximately 25% were penicillin or ampicillin intermediate; among these, 79% contained mosaic penA gene mutations. Less than 1% of isolates were penicillin, ampicillin, ciprofloxacin, or levofloxacin resistant.
Reference:
Potts, et al. The Journal of Infectious Diseases, Volume 225, Issue 11, 1 June 2022, Pages 1871–1875, https://doi.org/10.1093/infdis/jiac046.
