[e-drug] re: Meningococcemia

e-drug
1

Dear e-druggers,

While still in our mind the aftermath of flooding, which sacrificed many lives in the Philippines, comes the Tsunami tragedy, which killed thousand of our Asian brothers and sisters.

In the Philippines, the issue of meningococcal infection is ON, heating up health issues being exaggerated by Philippine media. This worsens the scenario, brings fear among the citizens, and big business for the drug industries. The Philippines Department of Health is not giving its official statement to HALT/STOP the issue; instead the secretary of health mentioned it as an outbreak instead of alert as used by the WHO. Citizens in Baguio City (Northen Luzon) live in disappointment and uncertainty since the issue is not that bad in reality?

Our organization will conduct a series of Forums to educate and raise peoples' awareness regarding the issue.

I am soliciting your expertise, websites, and materials regarding Meningococcemia to:

1. Understand its background clearly for documentation.
2. Confirm therapeutic effect of Rifampicin and Ciprofloxacin being used as prophylaxis (2 days administration).
3. How to handle the situation up to the community level.
4. Procedure of medication and what medicine is advisable.

Thank you in advance for your support.

Sincerely,

Rene Manangan, RPH
Council for Health and Development
Quezon City, Philippines
ipmanangan2@yahoo.com

[WHO recommends Cipro only for adults; Rifampicin can be given to all ages.

Contacts: prophylaxis should be considered for patients and close contacts (especially children). Ceftriaxone clears carriage, thus patients treated with ceftriaxone will generally not require rifampicin prophylaxis.

WB

For more WHO advice see:

http://mednet3.who.int/eml/disease_factsheet.asp?diseaseId=463

http://www.who.int/emc-documents/meningitis/whoemcbac983c.html

WHO Fact Sheet No. 141, Revised, May 2003
http://www.who.int/mediacentre/factsheets/2003/fs141/en/

Control of Epidemic Meningococcal Disease, WHO Practical Guidelines (Page 66), 2nd Edition, WHO/EMC/BAC/98.3
http://www.who.int/emc-documents/meningitis/docs/whoemcbac983.pdf

Meningococcal disease Link Page
http://www.who.int/csr/disease/meningococcal/en/

Core information for the development of immunization policy, 2002 update, Vaccines and Biologicals, World Health Organization, WHO/V&B/02.28, Original: English
http://www.who.int/vaccines-documents/DocsPDF02/www557.pdf

WHO Model Prescribing Information. Drugs used in bacterial infections. World Health Organization, 2001. 177 pages (Page 75), ISBN 92 4 140107 9 Sw.fr. 35.- / In developing countries Sw.fr. 24.50. Order No. 1150483.
     http://www.who.int/medicines/library/bacterial_model_pres/bacterial_content.shtml

Antimicrobial and Support Therapy for Bacterial Meningitis in children; Report of the meeting of June 18-20, 1997, held at World Health Organization, Geneva
http://www.who.int/csr/resources/publications/meningitis/WHO_EMC_BAC_98_2/en/
]

2

E-DRUG: Meningococcemia (2)
---------------------------

I can only help with your second question. There are actually three drugs
that are recommended for prophylaxis: rifampin, ceftriaxone and
ciprofloxacin. Here is some dosing information for each along with
references:

rifampin
    Adults and children 10 mg/kg, b.i.d. x 2 days
                                                (maximum 600 mg/day)

    Children <1 month 5 mg/kg, b.i.d. X 2 days
or

ceftriaxone
    Adults 5 mg/kg, I.M., single dose
                                                (maximum 250 mg)
    Children <15 years 125 mg, I.M., single dose
or

ciprofloxacin
    Adults 500 mg, single dose

1. Advisory Committee on Epidemiology. Guidelines for control of
meningococcal disease. Canadian Communicable Disease Report 1994;20:17-27.
2. Schwartz B, Al-Tobaiqi A, Al-Ruwais A, et al. Comparative
efficacy of ceftriaxone and rifampin in eradicating pharyngeal carriage of
group A Neisseria meningitidis. Lancet 1988;1:1239-42.
3. National Health and Medical Research Council. Guidelines for
the control of meningococcal disease in Australia. Canberra: Australian Govt
Publ Serv; 1996.

--
Joel Lexchin MD
121 Walmer Rd.
Toronto ON
Canada M5R 2X8
Tel: 416-964-7186
Fax: 416-923-9515
E mail: joel.lexchin@utoronto.ca

[Thanks, Joel! WB]