Which antibiotic is appropriate for chemoprophylaxis in close contacts of a patient with Neisseria meningitidis meningitis?

• A. Amoxicillin
• B. Rifampin
• C. Ciprofloxacin
• D. Erythromycin

Answer: (B)

Preventing the spread of Neisseria meningitidis among close contacts relies on eliminating nasopharyngeal carriage. Rifampin is ideal because it rapidly clears meningococcal carriage and achieves good concentrations in the nasopharynx and across mucosal surfaces, making it highly effective at preventing secondary cases in household and other close-contact settings. It works well across both children and adults, and the short course aids adherence. While alternatives like a single dose of ciprofloxacin or ceftriaxone can be used in certain situations (such as pregnancy or intolerance to rifampin), rifampin remains the standard first-line choice for meningococcal chemoprophylaxis. Amoxicillin and erythromycin do not reliably eradicate meningococcal carriage and are not appropriate for this purpose.