Antibiotics for preventing meningococcal infections

Area of Science:

• * Infectious Diseases
• * Microbiology
• * Pharmacology

Background:

• * Meningococcal disease is a contagious bacterial infection caused by Neisseria meningitidis (N. meningitidis).
• * Household contacts face the highest risk of secondary infection within seven days of a case detection.
• * Prophylaxis is crucial for close contacts and populations with high N. meningitidis carriage rates.

Purpose of the Study:

• * Evaluate prophylactic regimens for preventing secondary meningococcal disease.
• * Assess effectiveness in high-risk carrier populations.
• * Determine efficacy in eradicating N. meningitidis from pharyngeal carriers.
• * Review adverse effects and the development of antibiotic resistance.

Main Methods:

• * Conducted systematic electronic searches of major biomedical databases (CENTRAL, MEDLINE, EMBASE, LILACS).
• * Included randomized or quasi-randomized clinical trials on antibiotic prophylaxis and N. meningitidis eradication.
• * Performed independent quality appraisal and data extraction by two reviewers.
• * Analyzed dichotomous data using relative risk (RR) and 95% confidence intervals (CI).

Main Results:

• * Ciprofloxacin, rifampin, minocycline, and ampicillin effectively eradicated N. meningitidis one week post-treatment versus placebo.
• * Rifampin and ciprofloxacin maintained efficacy at one to two weeks.
• * Rifampin showed sustained efficacy up to four weeks, but resistant isolates emerged.
• * Ceftriaxone demonstrated greater efficacy than rifampin at one to two weeks.

Conclusions:

• * Ciprofloxacin or ceftriaxone are preferred over rifampin due to potential for resistant N. meningitidis strains.
• * All three agents (ciprofloxacin, ceftriaxone, rifampin) show effectiveness up to two weeks.
• * Further comparative trials of ceftriaxone, ciprofloxacin, and rifampin are needed.