Emergence of Non-Ceftriaxone-Susceptible Neisseria meningitidis in India

Meningococcal disease is endemic in Delhi, and there has been an increase in the number of cases of meningococcal disease occurring in Delhi in recent years (4). Antimicrobial therapy is the cornerstone of meningococcal disease management. Expanded-spectrum cephalosporins (ceftriaxone and cefotaxime) are widely accepted antimicrobials for the treatment of patients suspected of having meningococcal disease (1, 5). In India, there has been a paucity of studies on the antimicrobial sensitivity of Neisseria meningitidis. Drug susceptibility testing on the isolates obtained from a recent spurt of cases in and around Delhi in early 2005 revealed increased resistance to ciprofloxacin while all isolates were susceptible to ceftriaxone (4). We report on the emergence of clinical isolates of N. meningitidis that were found to be nonsusceptible to ceftriaxone and cefotaxime and were associated with potential therapeutic failure to ceftriaxone therapy.