Common antimicrobial prophylaxis:

• Exposure to meningococcal infection - Ceftriaxone, ciprofloxacin, or rifampin
• High risk for endocarditis and undergoing surgical or dental procedures - Amoxicillin
• History of recurrent UTIs - TMP-SMX
• Malaria prophylaxis for travelers - Atovaquone-proguanil, mefloquine, doxycycline, primaquine, or chloroquine
• Pregnant woman carrying group B strep - Intrapartum penicillin G or ampicillin
• Prevention of gonococcal conjunctivitis in newborn - Erythromycin ointment on eyes
• Prevention of postsurgical infection due to S aureus - Cefazolin
• Prophylaxis of strep pharyngitis in a child with prior rheumatic fever - Benzathine penicillin G or oral penicillin V

Neisseria gonorrhoeae Gonococcal meningitis

• No polysaccharide capsule
• No maltose acid detection
• No vaccine due to antigenic variation of pilus proteins
• Sexually or perinatally transmitted
• Causes gonorrhea, septic arthritis, neonatal conjunctivitis (2-5 days after birth), pelvic inflammatory disease, and Fitz-Hugh-Curtis syndrome (RUQ abdominal pain referred to the right shoulder, perihepatic adhesions)
• Diagnosed with NAT
• Condoms decrease sexual transmission
• Erythromycin eye ointment prevents neonatal blindness
• Treatment: ceftriaxone (+ azithromycin or doxycycline, for possible chlamydial coinfection)

All neonates should receive topical prophylaxis against bacterial conjunctivitis caused by Neisseria gonorrhoeae and C. trachomatis. Erythromycin is the most commonly used prophylactic agent and functions by binding to the bacterial 50s ribosomal subunit and preventing bacterial protein synthesis.

Neisseria meningitidis Meningococcal meningitis

• Yes polysaccharide capsule
• Yes maltose acid detection
• Vaccine (type B vaccine)
• Respiratory and oral secretion transmission
• Causes meningococcemia with petechial hemorrhages and gangrene of toes, meningitis, Waterhouse-Friderichsen syndrome (adrenal insufficiency, fever, DIC, shock)
• Diagnosed via culture-based tests or PCR
• Rifampin, ciprofloxacin, or ceftriaxone prophylaxis in close contacts
• Treatment: ceftriaxone or penicillin G