Question 151

Question:

A 22-year-old college student that is confused and lethargic is brought to the emergency room. His roommates say he was complaining of a severe headache and neck stiffness last night. Vital signs are remarkable for a temperature of 104.3, blood pressure of 80/60 and heart rate of 120. Physical exam reveals a purpuric rash on the patient’s chest. Lumbar puncture reveals a high neutrophil count.
What treatment should be given to his roommates as prophylaxis?

Correct Answer: D.  Rifampin

The patient described has acute bacterial meningitis, the cause of which is most likely N. meningitidis (given the patients age, clinical history, and the characteristic purpuric rash of DIC.) Rifampin is indicated for prophylaxis of close contacts of patients with meningococcal meningitis.
Ceftriaxone is indicated for the treatment of meningococcal meningitis, but not the prophylaxis of contacts.
Vancomycin is not indicated in this situation as it only covers gram positive organisms.
Acyclovir is also not indicated in this situation as the lumbar puncture results suggest this patient’s meningitis is bacterial and not due to a virus.
Doxycycline is not indicated for the prophylaxis of meningococcal meningitis.