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Emerging strain of group Y meningococcus resistant to penicillin and ciprofloxacin :

June 18, 2020

Health officials have found a strain of the bacteria that causes meningococcal disease that is resistant to penicillin and ciprofloxacin. They recommend using other antibiotics for initial treatment and prophylaxis.

The Centers for Disease Control and Prevention (CDC) identified Neisseria meningitidis (N. meningitidis)serogroup Y isolates from 11 cases in 2019-’20 that contained a gene associated with penicillin resistance and a mutation associated with ciprofloxacin resistance. Isolates from another 22 cases in 2013-’20 were resistant to penicillin only. The CDC detailed the findings and recommendations Thursday in a new Morbidity and Mortality Weekly Report and a Health Alert Network advisory.

The 33 cases with resistant isolates were found in California, Colorado, Florida, Georgia, Kansas, Maryland, New Jersey, New York, North Carolina, Pennsylvania, Texas and Washington. The majority occurred in young children and older adults, and most of the patients were Hispanic.

Prompt treatment for bacterial meningitis is critical. Clinicians can use ceftriaxone or cefotaxime until they know whether they have a case resistant to penicillin, according to the CDC.

“They should go ahead and screen (isolates) for resistance, but they shouldn’t wait for the resistance testing to come back before they treat,” said Yvonne A. Maldonado, M.D., FAAP, chair of the AAP Committee on Infectious Diseases.

Close contacts of patients with meningitis should receive antibiotic prophylaxis. Instead of ciprofloxacin, they can take a two-day course of rifampin or a single injection of ceftriaxone. Another option for communities where resistance has been detected is a single dose of azithromycin, although its effectiveness has been detailed in only one study.

Health departments should continue submitting meningococcal isolates to the CDC for testing and report suspected resistant cases.

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