The risk of meningeal disease is greatest in persons who have had close contact with the index patient in the past seven days. Antibiotic prophylaxis should be offered to those who have shared living accommodations or had oral contact with an index patient within the past seven days. Infants and young children who share day care with a patient with meningitis should be considered for prophylaxis, but classmates of older children may not require treatment unless contact is unusually close or two or more cases occur in the same class. Rifampicin is contraindicated in patients with severe liver disease and during pregnancy. It may also interfere with anticoagulant and contraceptive medications and can cause discoloration of body fluids.
Excessive menstruation is a common cause of discomfort and lifestyle disruption for many women.
When excessive bleeding occurs in regular cycles, the patient is likely to be ovulating, whereas irregular heavy bleeding usually indicates an anovulatory cause such as puberty, perimenopause or polycystic ovarian syndrome. If a significant pathologic cause has been excluded, nonsteroidal anti-inflammatory drugs are a logical first line of treatment since they reduce prostaglandin levels. Mefenamic acid, ibuprofen, naproxen and diclofenac are all effective therapies and provide the added benefit of pain relief for women who have dysmenorrhea. In some countries, antifibrinolytic agents such as tranexamic acid are used to depress fibrinolytic activity, and blood loss may be reduced by up to one half. Combined oral contraceptive pills also reduce blood loss by approximately 40 percent, depending on the type of agent used, and are especially useful in regulating menstrual cycles.