Side effects from ciprofloxacin following meningococcal disease prophylaxis in a high school

A distribution clinic was held to dispense ciprofloxacin (cipro) prophylaxis when two Los Angeles County high school (HS) students were reported to the health department (HD) with invasive meningococcal disease (MD). Despite revealing cases' names to permit assessment of direct case contact, 2861 persons of over 3100 in attendance requested and received cipro. Due to concerns of over-prophylaxis and potential side effects associated with cipro in adolescents, a survey was self-administered to students 2 weeks later to evaluate reasons for clinic attendance and to quantify side effects. Data included reasons for attendance and perception of risk for acquiring MD, rated on a 1 to 5 scale; type of contact with cases; and side effects (SE). Of 2888 students, 1624 completed surveys; 1390 took cipro. Only 3% reported direct contact with the case(s). Headache (17%) and stomachache (10%) were the most common SE. Two students sought medical care for allergic reactions. Students rated their risk of acquiring MD very low (mean=1.49). The highest rated reasons for attendance were parental influence (mean= 3.97) and directives from HS (mean=3.34). Single-dose cipro appears safe for adolescents as few serious side effects (<1%) and no joint disorders were reported; however, many students received prophylaxis unnecessarily. HDs should work with schools to provide adequate opportunity to prepare and disseminate risk messaging for parents regarding unnecessary antibiotic use versus risk of exposure to disease.