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Invasive meningococcal disease: Impact of short course therapy. A DOOR/RADAR study
Carmen Cabellos1, Ivan Pelegrín1, Eva Benavent1
1Infectious Diseases Department, IDIBELL-Hospital Universitari de Bellvitge, Universitat de Barcelona, Barcelona, Spain.
Background:
Invasive meningococcal disease is a severe infection. The appropriate duration of antibiotic therapy is not well established.
Methods:
Two hundred and sixty-three consecutive patients with invasive meningococcal disease treated with 4 days' antibiotic therapy were compared with 264 consecutive patients treated previously at the same center with 7 days' antibiotic therapy. A Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR) study was also performed.
Results:
No relapses were recorded in any patient. Patients on the 4-day course were 63% female, with a median age of 23 years old (IQR 16-54) and patients on the 7-day course were 61% female, with a median age of 17 years old (IQR 12-43). Case fatality rate was 7% in the 4-d patients and 6% in the 7-d patients (p = 0.582). Neurological sequelae were recorded in 6% of the 4-d group and in 7% of the 7-d group ((p = 0.509) and cutaneous sequelae in 3% in both groups. There were no statistical significant differences between the groups in terms of clinical characteristics, laboratory findings or complications. The probability that a patient had a randomly chosen DOOR better with the 4-day regimen than with the 7-day regimen was 80.4% [95% CI 80.1-80.7%].
Conclusion:
Invasive meningococcal disease may be successfully treated with a four-day course of antibiotic therapy without relapses.
Insights
A four-day antibiotic course effectively treats invasive meningococcal disease, showing no relapses or significant differences in outcomes compared to a seven-day regimen. This shorter duration offers a safe and viable alternative for patients.
Area of Science:
- Infectious Diseases
- Clinical Microbiology
- Pharmacotherapy
Background:
- Invasive meningococcal disease (IMD) is a serious bacterial infection.
- Optimal antibiotic treatment duration for IMD is not definitively established.
- Current treatment guidelines lack clear recommendations on the shortest effective antibiotic course for IMD.
Purpose of the Study:
- To compare the efficacy and safety of a 4-day antibiotic regimen versus a 7-day regimen for treating invasive meningococcal disease.
- To evaluate clinical outcomes, including relapse rates, case fatality, and sequelae, between the two treatment durations.
- To assess patient-reported outcomes using the Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR) methodologies.
Main Methods:
- A comparative study involving 263 patients treated with a 4-day antibiotic course and 264 patients previously treated with a 7-day course.
- Utilized Desirability of Outcome Ranking (DOOR) and Response Adjusted for Duration of Antibiotic Risk (RADAR) for outcome assessment.
- Analyzed clinical characteristics, laboratory findings, complications, case fatality rates, and neurological/cutaneous sequelae.
Main Results:
- No relapses were observed in either the 4-day or 7-day treatment groups.
- There were no statistically significant differences in case fatality rates (7% vs. 6%) or neurological/cutaneous sequelae between the groups.
- The 4-day regimen demonstrated a significantly higher probability (80.4%) of achieving a better outcome compared to the 7-day regimen.
Conclusions:
- A 4-day course of antibiotic therapy is a safe and effective treatment for invasive meningococcal disease.
- Shorter antibiotic durations can be utilized without compromising patient outcomes or increasing the risk of relapse.
- These findings support the potential for de-escalation of antibiotic therapy duration in IMD management.
