Prophylaxis of Meningococcal Septicaemia and Meningitis, Prescriptions (236)

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A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient

Advice for Hospital Pharmacists and Public Health On Call Staff

All suspected cases of meningococcal disease are notified to the Greater Glasgow & Clyde NHS Board, Public Health Protection Unit (PHPU).With improved immunisation programmes, the number of cases has fallen significantly in recent years but the risk remains.Treatment of the individual case in an acute hospital is accompanied by management of the public health implications in primary care. Typically, specialists in Communicable Disease will identify close family and friends of the patient who may require antibiotic prophylaxis. This should be given as soon as possible (ideally within 24 hours) after diagnosis of the index case.

PHE Guidance recommends ciprofloxacin as the chemoprophylaxis of choice and rifamipicin as a suitable alternative. Ciprofloxacin is recommended in all age groups, and in pregnancy, except in cases of known ciprofloxacin hypersensitivity. A patient information leaflet should always be provided. Please see BNF for prescribing information

Ciprofloxacin

Adults and children aged12 years and over: 500 mg as a single dose
*Children aged 5 - 11 years: 250 mg as a single dose
*Children 1 - 4 years: 125 mg as a single dose
*Infant < 1 year: 30mg/kg to a maximum 125mg as a single dose

*Note: unlicensed indication in children.

Ciprofloxacin suspension contains 250mg/5ml and requires reconstitution. Tablets are scored and may be halved and dispersed in water but avoid milk/yoghurt or mineral-fortified drinks.

The absorption of oral ciprofloxacin can be reduced by antacids and both calcium and iron containing preparations. It is therefore advised that ciprofloxacin should be taken 2 hours before or 4 hours after antacids, and that the administration of ciprofloxacin and either iron or calcium containing preparations should be separate by at least 2 hours.

Rifampicin

Adults and children aged 12 years and over: 600 mg twice daily for 2 days
Children aged 1-11 years: 10mg/kg twice daily (max. per dose of 600mg) for 2 days
Infants (under 12 months): 5mg/kg twice daily for 2 days

Capsules should be swallowed whole with a glass of water or juice (but avoid milk). A rifampicin suspension is available.

Interactions between rifampicin and other medications, such as anticoagulants, phenytoin, and contraceptives, should be considered. Please see BNF for a full list of interacting medications.

Please note: In pregnancy and breast feeding either ciprofloxacin, IM ceftriaxone (at a dose of 250mg for 1 dose) or azithromycin (at a dose of 500mg for 1 dose) may be used, although the last two are unlicensed indications.

Supply of Medication

During working hours for contacts at the receiving hospital, the preference would be the use of pre labelled patient packs or, if these are not available, a prescription via the hospital pharmacy. PHPU will contact the ward medical staff and ask them to prescribe appropriate chemoprophylaxis for confirmed contacts at patient’s bedside. Full documentation should be maintained. Orion cannot be used for non-admitted patients and a paper prescription stating “meningitis prophylaxis for contact” should be used. Paper prescription pads, if not available on the ward, can be issued from pharmacy. Out of hours, the preference would be the use of pre-labelled patient packs available via acute site emergency stock locations, as shown in table 1. If English is not the patient’s first language, interpretation facilities are available.

During working hours for contacts in the community, the preference is for the prescription to be provided by the general medical practice and dispensed by a community pharmacy. PHPU will ask the contact’s GP to arrange a prescription, usually for the next day. If out of hours, supply would be made by the Primary Care Emergency Centres (PCEC). If there are any issues, such as the contact not being registered with a GP, PHPU can also issue a prescription.

The options for supply of these prescriptions are as follows. The choice depends on whether the index case has been admitted, time of admission and convenience for affected individuals.

  1. Hospital prescription dispensed by hospital pharmacy or utilising pre-labelled patient packs held in hospital A&E departments, selected wards or emergency cupboards (Table 1)
  2. Primary Care Emergency Centres (PCECs).
  3. Community pharmacy supply (via GP or HBP prescriptions – the latter should be reserved for exceptional circumstances).

Notes: Patient pre packs (1x 500mg ciprofloxacin) are held in the NHS GGC acute hospitals (A&E, selected wards and emergency cupboards) as shown in Table 1.

Table 1

2. The PCECs will each hold a small stock – enough for six courses of treatment including one course of ciprofloxacin suspension. The hours of opening vary by locality and opening hours can be confirmed by phoning the HUB on 0141 636 8412. Further information on the locations can be found at here. The centres include:

  • Easterhouse Health Centre (Currently closed- contact HUB for up to date information)
  • Gartnavel General Hospital (Currently closed- contact HUB for up to date information)
  • Inverclyde Royal Hospital
  • Queen Elizabeth University Hospital Glasgow (Currently closed- contact HUB for up to date
    information)
  • Royal Alexandra Hospital
  • Stobhill Hospital (New)
  • Victoria Hospital (New)

3. Some community pharmacies have extended hours of opening - this can be checked via the NHS Inform Service Directory . It is advisable to phone the pharmacy to confirm stocks are available especially if either rifampicin or ciprofloxacin suspension is required.

4. Hospital pharmacies hold stock of ciprofloxacin if large numbers of contacts required treatment. Pharmacy Services has agreed to the principle that the hospital pharmacist should respond to an urgent call out of hours to supply ciprofloxacin stock, in exceptional circumstances.

Please note: For patients unable to swallow tablets, the appropriate number of tablets can be dispersed in water but avoid milk/yoghurt or mineral- fortified drinks.

Not all community pharmacies routinely stock rifampicin or ciprofloxacin suspension. It is advisable to phone the pharmacy to confirm stocks are available. Supply from hospital would be via the hospital pharmacy (in hours) or on call pharmacist (out of hours).

Last reviewed: 19 August 2021

Next review: 22 July 2024

Author(s): Liz McGovern

Version: 10

Author Email(s): [email protected]

Approved By: Antimicrobial Utilisation Committee

Document Id: 236