New York’s department of health issued an advisory last week cautioning healthcare organizations to stop prescribing the antibiotic ciprofloxacin as prophylactic treatment for people who have come in contact with someone who has meningococcal disease. The department created the recommendation based on an increase in antimicrobial resistance with ciprofloxacin. In New York City, 6 of the 35 (17%) isolates from patients diagnosed with invasive meningococcal disease from July 23, 2023, to July 22, 2024, were ciprofloxacin-resistant. Rifampin, ceftriaxone, and azithromycin are the suggested alternatives. However, azithromycin is not the top preferred choice among the alternative options because its use in this case is not as well studied.
Treatment remains the same: The department based its recommendation on the Centers for Disease Control and Prevention’s threshold for discontinuing ciprofloxacin post-exposure prophylaxis and the rise in resistance nationwide. Treatment recommendations for suspected or confirmed meningococcal disease have not changed, including the use of cefotaxime or ceftriaxone.