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Wisconsin DHS Health Alert #72: Ciprofloxacin-Resistant Meningococcal Disease in Wisconsin

Bureau of Communicable Diseases

September 24, 2026

Key points

• The Wisconsin Department of Health Services (DHS) recently identified a case of invasive meningococcal disease caused by ciprofloxacin-resistant Neisseria meningitidis.
• This is the fifth ciprofloxacin-resistant case since June 2024. Since then, approximately 30% of invasive meningococcal disease cases in Wisconsin have been resistant to ciprofloxacin.
• Wisconsin is following guidance from the Centers for Disease Control and Prevention (CDC) to discontinue use of the antibiotic ciprofloxacin for the prophylaxis of contacts until 24 months have passed without any reported cases caused by ciprofloxacin-resistant strains.
• Antibiotic prophylaxis with ciprofloxacin in areas with ciprofloxacin resistance can result in prophylaxis failure.
• Health care providers should not prescribe ciprofloxacin to prevent meningococcal disease in close contacts of people with invasive meningococcal disease. Instead, providers should prescribe rifampin or ceftriaxone in accordance with CDC's recommended chemoprophylaxis regimens for high-risk contacts.

Background

Meningococcal disease is caused by the bacterium, Neisseria meningitidis. The bacteria are spread to people who have had close, direct contact with respiratory and throat secretions (saliva or spit) from someone who has meningococcal disease. Close contact includes sharing items that come in contact with the mouth (for example, water bottles, eating utensils, lip balm, cigarettes, and smoking materials).

People will not catch the bacteria through casual contact or by breathing air where someone with meningococcal disease has been. The bacteria can occasionally spread to people who spend long periods in the same space together, such as roommates.

Recommendations for clinicians

Wisconsin is following updated prophylaxis guidance to discontinue use of the antibiotic ciprofloxacin until 24 months have passed without any reported cases caused by ciprofloxacin-resistant strains. According to CDC guidelines, healthcare providers and public health staff should:

Discontinue ciprofloxacin use when both threshold criteria listed below have been met during a rolling 12-month period:

• Two or more invasive meningococcal disease cases caused by ciprofloxacin-resistant strains have been reported.
• Cases caused by ciprofloxacin-resistant strains account for at least 20% of all reported invasive meningococcal disease cases.

Updated prophylaxis guidance will be followed until 24 months have passed without any reported meningococcal disease cases caused by ciprofloxacin-resistant strains statewide.

Clinicians should always be alert for signs and symptoms of both meningitis and bacteremia and suspect meningococcal disease in ill and rapidly worsening patients.  

• Meningitis causes fever, headache, stiff neck, vomiting, photophobia, and/or altered mental status. 
• Bacteremia does not usually cause headache and stiff neck. Instead, bacteremia causes more non-specific symptoms such as fever, chills, fatigue, vomiting, cold hands and feet, severe aches and pains, rapid breathing, and diarrhea.

For ill and worsening patients suspected to have meningococcal disease: 

• Prompt treatment is critical. Immediately start antibiotics in accordance with the CDC Clinical Guidance for Meningococcal Disease. 
• Order gram stain, culture, and polymerase chain reaction (PCR) testing on blood and cerebrospinal fluid (CSF) or other usually sterile fluids (not urine or sputum).
  • If CSF suggests bacterial meningitis or blood or CSF show gram-negative diplococci: 
    • Report the results immediately by telephone to the patient’s local or Tribal health department (LTHD) upon identification of a confirmed or suspected case. The LTHD shall then notify the state epidemiologist immediately of any confirmed or suspected cases. Submit a case report within 24 hours either electronically through the Wisconsin Electronic Disease Surveillance System (WEDSS), by mail, for fax using the Acute and Communicable Disease Case Report, F44151 (Word), or by other means.  
• If culture grows Neisseria meningitidis:
  • Send an isolate to the Wisconsin State Laboratory of Hygiene (WSLH) for antibiotic susceptibility and serotype testing*.
  • Contact WSLH at 800-862-1013 with questions.

*DHS understands some facilities use refence laboratories for testing. DHS is requesting that an additional isolate be sent to WSLH to save time and avoid the need to request specimens from out-of-state reference labs. Isolates sent to reference labs can also be lost, discarded, or become non-viable during the process. Additionally, reference labs usually do not perform the necessary serotyping. 

To prevent the spread of meningococcal disease:

• Prescribe antibiotics to close contacts of people with invasive meningococcal disease.
  • Do not prescribe ciprofloxacin. This recommendation is based on CDC's guidance for preventing antibiotic-resistant Neisseria meningitidis.
  • Instead, providers should prescribe rifampin or ceftriaxone in accordance with CDC's recommended chemoprophylaxis regimens for high-risk contacts (see Table 1).
• Vaccinate with MenACWY and MenB containing vaccine according to the American Academy of Pediatrics' recommended schedule (PDF).

Further information regarding meningococcal vaccines, disease, and case reporting can be found on the DHS website.  

Thank you for your collaboration.
Sincerely,
Ryan Westergaard, MD, PhD, MPH
Chief Medical Officer and State Epidemiologist
Bureau of Communicable Diseases
Division of Public Health
Wisconsin Department of Health Services

Questions

Questions regarding this health alert may be directed to the Bureau of Communicable Disease at DHSDPHBCD@dhs.wisconsin.gov.

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