Table 2. Vaccine and antibiotic recommendations for children receiving eculizumab [12, 13, 17, 18].

Meningococcal vaccinations available for children (United States)	Dosing schedule
Hib-MenCY	≥ 6 weeks of age, 4 dose series at 2, 4, 6, and 12 – 15 months of age
MenACWY-CRM	≥ 2 – 7 months of age, 4 dose series at 2, 4, 6, and 12 months of age
	≥ 7 – 23 months of age, 2 dose series 3 months apart with 2nd dose given at > 12 months of age
MenACWY-D	≥ 9 months of age, 2 dose series 3 months apart

The eculizumab package insert recommends antibiotic prophylaxis for 2 weeks only if eculizumab is started < 2 weeks after the meningococcal vaccination. In children, we recommend indefinite antibiotic prophylaxis during eculizumab treatment and meningococcal, pneumococcal, and Haemophilus b immunizations in patients ≥ 6 weeks. Antibiotic prophylaxis options: Ampicillin: 50 mg/kg/dose IV every 24 hours, maximum 1,000 mg/dose. Penicillin VK: < 5 years of age, 125 mg PO twice daily; ≥ 5 years of age, 250 mg twice daily. Amoxicillin: 20 mg/kg/day PO divided once or twice daily, maximum 500 mg/day. Erythromycin: (if penicillin-allergic), < 3 years of age, 125 mg PO twice daily; ≥ 3 years of age, 250 mg PO twice daily. Hib-MenCY = meningococcal polysaccharide (groups C/Y) and Haemophilus b tetanus toxoid conjugate vaccine; MenACWY-CRM = meningococcal (groups A/C/Y and W-135) oligosaccharide conjugated to CRM197 protein vaccine; MenACWY-D = meningococcal (groups A/C/Y and W-135) polysaccharide diphtheria conjugate vaccine; IV = intravenous; PO = oral.