Guidelines for the Early Clinical and Public Health Management of ...

Guidelines for the Early Clinical and Public Health Management of Bacterial Meningitis (including Meningococcal Disease)
Dose of Rifampicin:
Children 0-12 months: - 5 mg/Kg twice daily for two days
Children, 1-12 years: - 10 mg/Kg twice daily for two days (max 600 mg)
Children over 12 years and adults: 600 mg twice daily for two days.
The average doses of rifampicin are as follows 3 :
Age
Dose twice daily for two days
Suitable doses in children based on average weight for age are:
0-2 months 20 mg (1 ml*)
3-11 months 40 mg (2 ml*)
1-2 years 100 mg (5 ml*)
3-4 years 150 mg (7.5 ml*)
5-6 years 200 mg (10 ml*)
7-12 years 300 mg (as capsule/or syrup)
* Rifampicin syrup contains 100 mg/5 ml
Note: for paediatric doses- a small syringe should be provided for ease of administration
9.2 Ciprofloxacin
Ciprofloxacin is recommended as:
• The antibiotic of choice for those on the oral contraceptive pill.
• An alternative agent to rifampicin for chemoprophylaxis in adults and children aged two years and above.
It may be particularly useful when there is a setting with a large number of adult contacts (e.g. university
students). In this scenario an assessment of the logistics will guide the antibiotic choice. Also an assessment
of individual characteristics may suggest the use of ciprofloxacin e.g. those who are taking an oral
contraceptive or are utilising contact lenses.
Ciprofloxacin has a number of advantages over rifampicin. It is given as a single dose. It does not interact with
systemic hormonal contraceptives. It is more readily available in community pharmacies and does not affect contact
lenses.
Ciprofloxacin is contraindicated for those with hypersensitivity to the active substance, to other quinolones or to
any of the excipients (please refer to most recent summary of product characteristics (SPC) available at www.imb.
ie or www.medicines.ie. It is also contraindicated for concomitant administration with tizanidine (muscle relaxant
e.g. zanaflex). Ciprofloxacin should be used with caution in patients with a history of epilepsy or conditions which
predispose to seizures. Increased plasma levels of theophylline can occur following concurrent administration
(please see relevant current SPC for more detail).
Ciprofloxacin is usually not recommended in children due to induced arthropathy in juvenile animals but the ECDC
report detailed “abundant evidence of lack of joint damage was found in young children given ciprofloxacin.” 2
Individual case discussion is recommended when considering use of ciprofloxacin for children. Ciprofloxacin
suspension is currently provided on an unlicensed basis in Ireland - other versions of ciprofloxacin are licensed.
Ciprofloxacin is not recommended for pregnant women.
Anaphylactic reactions, although very uncommon, have been reported in about one or less than one in one thousand
people following single-dose ciprofloxacin. 65,66 A recent Irish report found an anaphylactic rate of 0.3 in 1,000 people
and a general allergic reaction rate of 2.2 in 1,000. In this incident of the 3,605 individuals who received ciprofloxacin
there were seven mild allergic reactions (rashes), one moderate non-specific reaction and one anaphylactic
reaction. 67
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