Question

A young male presents with meningococcal meningitis and allergy to penicillin. Which is the most suitable drug?

• A. Chloramphenicol
• B. Meropenem
• C. Ciprofloxacin
• D. Teicoplanin

Hint:

Need a non-beta-lactam with strong CSF penetration against Neisseria.

Answer 1

The Correct Option is A

Step 1: First-line treatment of meningococcal meningitis is penicillin G or a third-generation cephalosporin such as ceftriaxone. Here both are problematic because the patient is penicillin allergic, and cephalosporins carry cross-reactivity risk.

Step 2: The drug needed must kill Neisseria meningitidis and cross the blood-brain barrier well. Chloramphenicol is bactericidal against meningococcus, achieves excellent CSF penetration, and is the standard alternative in a penicillin-allergic patient. So option A fits.

Step 3: Meropenem is effective but, as a beta-lactam (carbapenem), still carries a risk of cross-reactivity in penicillin allergy, so it is not the safest first choice here. Option B is less ideal.

Step 4: Ciprofloxacin is used for meningococcal prophylaxis (to clear nasopharyngeal carriage), not for treating established meningitis. Option C is wrong for treatment.

Step 5: Teicoplanin is a glycopeptide active against gram-positive organisms only and has no action against the gram-negative meningococcus. Option D is wrong.

Conclusion: The most suitable drug is chloramphenicol, option A.