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August 2, 1976

Prophylaxis Against Meningococcal Disease

JAMA. 1976;236(5):459-461. doi:10.1001/jama.1976.03270050015020

THE PRACTICING physician finds himself in an uncomfortable position in the management and containment of many infectious diseases. His difficulties multiply, moreover, when the illness he confronts is potentially lethal, significantly communicable, and possibly preventable, as is the case with meningococcal infection. He has learned in his training and continues to be reminded1,2 of the fact that antimicrobial prophylaxis is often ineffective and illadvised.

Authoritative recommendations3,4 against the use of chemoprophylaxis for contacts of patients with meningococcal infection (except when the infecting organisms are known to be susceptible to sulfonamides) have recently been published. The fact that these points of view are debated5 does not make the practitioner's decision easier. On the one hand, he wishes to "do no harm," to offer treatment only when it may be expected to help his patient, and to practice "scientific" medicine. On the other hand, he wants to intervene whenever