Prophylactic use of antibiotics for prevention of meningococcal infections: systematic review and meta-analysis of randomised trials

Abstract

A systematic review and meta-analysis of randomised controlled trials was performed in order to study the effectiveness of prophylactic treatment regimens in preventing secondary cases of meningococcal disease (i.e., those contracted after contact with a person with meningococcal disease) and in eradicating Neisseria meningitidis from the pharynx of healthy colonised individuals. The Medline, Embase, and Lilacs databases, the Cochrane Library, and the references of all studies identified were systematically searched for relevant trials. Two reviewers independently applied selection criteria, performed quality assessment, and selected data. Relative risks were pooled using a fixed effects model unless heterogeneity assessed by the I2 statistic and chi-square test was found. In such cases, a random effect model was used. There were no cases of meningococcal disease following treatment with antibiotics or placebo, thus effectiveness regarding prevention of future disease could not be directly assessed. Compared with placebo, ciprofloxacin (RR = 0.04; 95%CI, 0.01-0.12), rifampin (RR = 0.17; 95%CI, 0.12-0.24), minocycline (RR = 0.30; 95%CI, 0.19-0.45), and penicillin (RR = 0.47; 95%CI, 0.24-0.94), proved effective at eradicating Neisseria meningitidis 1 week after treatment. After 1-2 weeks, only ciprofloxacin (RR = 0.03; 95%CI, 0.00-0.42) and rifampin (RR = 0.20; 95%CI, 0.14-0.29) still proved significantly effective when compared with placebo. Rifampin continued to be effective (RR = 0.24; 95%CI, 0.16-0.37) compared with placebo until up to 4 weeks post treatment. Rifampin was the only drug to which resistance developed. Given that the use of rifampin in an outbreak setting might lead to the circulation of isolates resistant to rifampin, the use of ciprofloxacin and ceftriaxone should be considered.

Atypical hemolytic uremic syndrome in first trimester pregnancy successfully treated with eculizumab

“…One retrospective study during STEC-mediated HUS outbreak in Germany also reported simultaneous treatment with antibiotic for meningococcal prophylaxis in 98% of patients treated with eculizumab [24, 25]. Rifampin, as one of the antibiotic options, was proven effective at eradicating N. meningitidis up to four weeks after treatment when compared with placebo [26, 27]. This case and the discussion highlight the use of the monoclonal antibody, eculizumab, as a viable option in the treatment of aHUS in pregnant women.…”

Clinical implications of meningococcal disease

“…Chemoprophylaktika sind Rifampicin, Ciprofloxacin und Ceftriaxon, deren "Eradikationswirksamkeit" bei Meningokokken belegt ist (3). Rifampicin ist in Deutschland weiterhin Mittel der ersten Wahl (10).…”

“…Rifampicin ist in Deutschland weiterhin Mittel der ersten Wahl (10). Nach einer aktuellen Metaanalyse wird im angloamerikanischen Raum derzeit empfohlen, Ceftriaxon und Ciprofloxacin zu bevorzugen, weil bei Rifampicin Resistenzentwicklungen zu befürchten sind (3).…”

Multilaboratory Evaluation of Disk Diffusion Antimicrobial Susceptibility Testing of Neisseria meningitidis Isolates

“…Applying the newly approved CLSI breakpoints to 325 CDC Active Bacterial Core surveillance isolates recovered between 1997 and 2002 revealed that 13.2% of the isolates were not susceptible to penicillin (MIC Ն 0.12 g/ml) and 5.8% were not susceptible to ampicillin (MIC Ն 0.25 g/ml) and that 52.7% were resistant to sulfisoxazole (MIC Ն 4 g/ml), 55% to trimethoprim-sulfamethoxazole (MIC Ն 0.25 g/ml), and 1.5% to rifampin (MIC Ն 1 g/ml) (J. H. Jorgensen Clinical microbiology or public health laboratories may receive requests to perform susceptibility testing of isolates from an in-dividual patient when the patient is not responding clinically, when a cluster of meningococcal cases occurs, or when an outbreak is recognized and appropriate prophylactic agents need to be identified to control the spread of infections. For example, the inability to recognize rifampin-resistant isolates early was responsible for the failure of prophylactic rifampin to prevent meningococcemia among close contacts of patients (16,21). In such instances, laboratories have sometimes performed MIC determinations using a commercial gradient diffusion method (11,20,28).…”