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The following information is an extract from Letters to the Editor - Antibiotic guidelines for meningococcal prophylaxis. Leunig MJ and Keil. MJA 1998;169:396. In reply Collignon P. MJA 1998;169:396, outlined in the Medical Journal of Australia, 5 October 1998.
The current edition (10th) of Therapeutic Guidelines: antibiotic includes a significantly increased recommended dose for ceftriaxone, when used as prophylaxis for meningococcal disease, compared to previous editions and with other published expert opinion.
Expert groups within Australia and overseas currently recommend a ceftriaxone dose of 5 mg/kg to a maximum of 250 mg intramuscularly (IM) as a single dose for adults, and 125 mg IM for children under 15 years of age.
There is no evidence to suggest that the increased dose (2 g IM) published in Therapeutic Guidelines: antibiotic is either necessary or superior to the recommended lower dose regimen in eradicating carriage. The established efficacy of the recommended dose, with comparable clearance rates in excess of 95% at one and two weeks after therapy, has served as the basis for the dose recommendations used in most countries.
However, rifampicin is the prophylactic antibiotic of choice for contacts of patients with meningococcal disease. Ceftriaxone should only be used in specific situations where rifampicin is considered unsuitable, such as in pregnancy.
This article was published in Communicable Diseases Intelligence Volume 22, No 12, 26 November 1998.