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Antibiotics for preventing meningococcal infections
A Fraser1, A Gafter-Gvili, M Paul
1Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Israel, 49100. abigailf@clalit.org.il
The Cochrane Database of Systematic Reviews
|January 28, 2005
Summary
Ciprofloxacin and ceftriaxone are recommended for meningococcal prophylaxis due to effectiveness in eradicating Neisseria meningitidis carriers and concerns about rifampin resistance.
Area of Science:
- Infectious Diseases
- Microbiology
- Pharmacology
Background:
- Meningococcal disease, caused by Neisseria meningitidis (N. meningitidis), poses a high risk to close contacts and carriers.
- Prophylaxis is crucial for preventing secondary infections and managing high-risk populations.
Purpose of the Study:
- To evaluate the efficacy of various prophylactic treatments against meningococcal disease.
- To assess the eradication rates of N. meningitidis in carriers.
- To investigate adverse effects and the development of antimicrobial resistance.
Main Methods:
- Systematic review of randomized and quasi-randomized clinical trials.
- Searches conducted across multiple electronic databases (CENTRAL, MEDLINE, EMBASE, LILACS).
- Data extraction and analysis using relative risk (RR) and 95% confidence intervals (CI).
Main Results:
- Ciprofloxacin, rifampin, minocycline, and ampicillin showed effectiveness in eradicating N. meningitidis one week post-treatment.
- Rifampin and ciprofloxacin maintained efficacy at one to two weeks.
- Ceftriaxone demonstrated higher efficacy than rifampin at one to two weeks; rifampin use was associated with resistant isolates.
Conclusions:
- Ciprofloxacin or ceftriaxone are preferred over rifampin due to resistance concerns.
- Placebo-controlled trials are ethically questionable given proven benefits of prophylaxis.
- Further trials comparing ceftriaxone, ciprofloxacin, and rifampin are needed.