Meningococcal bug develops quinolone resistance

Experts bemoan the possible loss of this drug class for postexposure prophylaxis and call for increased emphasis on vaccination.

By Victoria Stagg Elliott, AMNews staff. March 10, 2008.

In some areas of North Dakota and Minnesota, Neisseria meningitidis has developed resistance to quinolone antibiotics. Public health officials recommend that ciprofloxacin, the drug from this family commonly prescribed to reduce the risk of illness in healthy people who have been exposed to this bacterium, no longer be used for this purpose.

The officials also want physicians outside the region to be alert to the possibility that the medication may not have the desired effect, according to statements issued by health departments in those states and a report in the Feb. 22 Morbidity and Mortality Weekly Report.

"Resistance may rise quickly," said Ruth Lynfield, MD, state epidemiologist for the Minnesota Dept. of Health. "People need to consider susceptibility testing for invasive meningococcal isolates."

Officials issued this advice in response to three cases determined to be quinolone-resistant. The circumstance has been documented elsewhere in the world, but these are the first cases in North America. However, because many laboratories don't carry out resistance testing, there may be many more cases here that have not been detected.

"We might not be picking them up. That's scary," said Neil Fishman, MD, vice president of the Society for Healthcare Epidemiology of America.

Physicians still have options, although less desirable ones. Other long-recommended drugs, rifampin and ceftriaxone, still can be used, and azithromycin has been added to the list when resistance to ciprofloxacin is a possibility. But experts are worried about losing one of the easier options for situations where prevention is critical.