Prophylaxis for close contacts of Neisseria meningitis is best accomplished with which antibiotic?

• A. Dapsone
• B. Rifampin
• C. Azithromycin
• D. Ceftriaxone

Answer: (B)

Preventing transmission from a meningococcal exposure relies on eradicating nasopharyngeal carriage of Neisseria meningitidis in those most at risk. Rifampin is the drug of choice for close contacts because it rapidly reduces nasopharyngeal carriage when given as a short course, effectively lowering the chance of secondary cases. It works well in both adults and children and has well-established dosing regimens for prophylaxis.

Alternatives exist for specific situations (for example, ceftriaxone can be used if rifampin is contraindicated, such as in certain pregnancy scenarios), but rifampin remains the best initial prophylaxis for routine close-contact prevention. Dapsone and azithromycin do not reliably prevent meningococcal carriage, so they’re not suitable choices for this indication.