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Pre-admission antibiotics for suspected cases of meningococcal diseaseSudarsanam TD, Rupali P, Tharyan P, Abraham OC, Thomas K
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SummaryPre-admission antibiotics for suspected cases of meningococcal diseaseMeningococcal disease is a contagious, bacterial disease caused by Neisseria meningitidis (N. meningitidis) that often leads rapidly to death. Administering antibiotics as soon as the condition is suspected, and while waiting for the diagnosis to be confirmed, has been advocated as a method of preventing death and the disabling consequences of this disease. We found no randomised controlled trials that compared pre-admission antibiotics with placebo or no intervention. In the one randomised controlled trial we identified, a single injection of either ceftriaxone (a relatively expensive, newer antibiotic) or a long-acting form of chloramphenicol (an inexpensive antibiotic) were found to be equally effective in preventing death and the disabling consequences in suspected, non-severe cases of meningococcal disease. Due to the serious complications of meningococcal disease, it would be difficult, for ethical reasons, to undertake randomised controlled trials comparing the use of antibiotics, as soon as the diagnosis is suspected, versus no antibiotics. However, further trials comparing different antibiotics in suspected meningococcal cases will provide insights that could help prevent death and the serious consequences of this disease.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2010 Issue 1, Copyright © 2010 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
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January 23. 2008 AbstractBackgroundMeningococcal disease begins suddenly and death can follow within hours. Pre-admission antibiotic therapy aims to prevent delay in starting therapy that occurs if bacterial confirmation is sought before instituting therapy. ObjectivesTo study the effectiveness and safety of pre-admission antibiotics versus no pre-admission antibiotics or placebo and of different pre-admission antibiotic regimens in decreasing mortality and morbidity in people suspected of meningococcal disease. Search strategyWe searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library, 2007, issue 1), MEDLINE (1966 to February 2007) and EMBASE (1980 to February 2007). Selection criteriaWe selected randomised controlled trials (RCTs) or quasi-RCTs, of all people with suspected meningococcal infection. We compared antibiotic treatment versus placebo or no intervention, or different antibiotic treatments administered before admission to hospital or confirmation of the diagnosis. Data collection and analysisTwo author authors independently assessed quality and extracted data from included trials. We calculated the relative risk (RR) and 95% confidence interval (CI) for dichotomous data. As only one trial fulfilled inclusion criteria, data synthesis was not performed. Main resultsNo RCTs were found that compared pre-admission antibiotics versus no pre-admission antibiotics or placebo. One open-label RCT evaluated a single dose of intramuscular ceftriaxone versus a single dose of intramuscular long acting (oily) chloramphenicol. Interventions did not differ significantly in mortality (RR 1.2, 95% CI 0.5 to 2.6; N = 510; 349 confirmed meningococcal meningitis; 26 deaths), nor in proportions of survivors who developed neurological sequelae (RR 1.2, 95% CI 0.6 to 2.2; N = 488; 36 with neurological sequelae), or that were classified as clinical failures (RR 0.8, 95% CI 0.4 to 1.8; N = 488, 25 clinical failures). No adverse effects of treatment were seen. No data were available for our secondary outcomes. Authors' conclusionsWe found no reliable evidence to support or refute the use of pre-admission antibiotics for suspected cases of meningococcal disease. Evidence from one RCT-during an epidemic of meningococcal meningitis, indicated that single intramuscular injections of ceftriaxone and long-acting chloramphenicol were equally effective and safe in preventing mortality and morbidity. The choice between these antibiotics would be based on affordability, availability, and patterns of antibiotic resistance. Further RCTs comparing different pre-admission antibiotics, including penicillin, including participants with severe illness are ethically justifiable and are needed to provide reliable evidence to clinicians in differing clinical settings. |