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No treatment necessary
11%
9/82
Oral rifampin
76%
62/82
Amoxicillin/clavulanate
7%
6/82
Hospitalize and observe
2%
2/82
Vancomycin
Select Answer to see Preferred Response
The patient has Neisseria meningitidis (or meningococcal) meningitis, with gram negative diplococci shown on gram stain. The girlfriend requires treatment because of long exposure to her boyfriend and contact with oral secretions. Oral rifampin is first-line prophylaxis for meningococcus. Meningococcus meningitis is frequently seen in areas where many individuals are cohabitating, such as college dorms and military barracks. As a result, it is recommended that those at high risk receive the meningococcal vaccine. Patients commonly present with fever, headache, neck stiffness, photophobia, altered mental status, and occasionally a petechial rash. Workup includes lumbar puncture with Gram stain, culture, and evaluation of susceptibilities. Bamberger discusses the diagnosis, management, and prevention of meningitis. He discusses meningococcus exposure antibiotic prophylaxis and recommends rifampin, ciprofloxacin, or ceftriaxone to all those in close contact with meningococcal patients for at least 8 hours or those in contact with oral secretions. Chaudhuri et al. present guidelines for management of bacterial meningitis. They state that infection of close contacts occurs at a rate of 2-4/1000, and recommend that asymptomatic contacts should still receive antibiotic prophylaxis. Incorrect answers: Answers 1,3,4,5: Rifampin is first line antibiotic prophylaxis for close contacts of meningococcal meningitis patients.
4.8
(6)
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