Fluoroquinolone-Resistant Neisseria meningitidis in North America

Contacts of persons with meningococcal disease usually receive prophylaxis with ciprofloxacin or rifampin. The MMWR reports three cases of fluoroquinolone-resistant Neisseria meningitidis in Minnesota and North Dakota in 2007 and early 2008.

The first case was a child in eastern North Dakota who became ill with meningitis in January 2007 and recovered fully. The second case was an adult in western Minnesota who died from meningococcal infection in early January 2008, and the third case was a college student from western Minnesota who developed headache, fever, and rash in late January 2008 and recovered completely. In all three cases, N. meningitidis was isolated from cerebrospinal fluid cultures and was found to be resistant to ciprofloxacin. Some contacts of these cases were treated with fluoroquinolones before antibiotic susceptibility results were available, and many subsequently were offered either rifampin or azithromycin. No contacts became ill.