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Abdelhamid AS, Loke YK, Abubakar I, Song F. Antibiotics for eradicating meningococcal carriages: Network meta-analysis and investigation of evidence inconsistency. World J Meta-Anal 2016; 4:77-87. [DOI: 10.13105/wjma.v4.i4.77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 06/28/2016] [Accepted: 07/18/2016] [Indexed: 02/05/2023] Open
Abstract
AIM To compare different antibiotics for eradicating the carriage of Neisseria meningitidis (N. meningitidis), and to investigate heterogeneity and evidence inconsistency.
METHODS From a search of PubMed and published systematic reviews, we identified 23 trials evaluating 15 antibiotics that could be connected in a trial network. The outcome of interest is the eradication of N. meningitidis. We used WinBUGS to conduct random-effects, mixed treatment comparisons. Heterogeneity and evidence inconsistency was investigated by meta-regression modelling and examining characteristics of trial participants and interventions evaluated.
RESULTS Rifampin, ciprofloxacin, minocycline, ceftriaxone, and azythromycin were statistically significantly (P < 0.05) more effective than placebo. The probability of being the best was 67.0% for a combination of rifampin and minocycline, 25.0% for ceftriaxone, 1.7% for azythromycin, and below 1% for the remaining regimens. Significant inconsistency between the direct and indirect estimates was observed for the comparison of rifampin and ciprofloxacin (P < 0.01), which may be caused by different types of carriers and different doses of ciprofloxacin.
CONCLUSION A range of prophylactic antibiotic regimens are effective for eradicating meningococcal carriages, and treatment choice will depend on the individual priorities of the patients and physicians. In clinical situations where complete eradication is considered to be of the utmost importance, a combination of rifampin and minocycline seems to offer the highest likelihood of success. Ceftriaxone as a single intramuscular injection is also likely to be more effective as compared with the other two antibiotics (ciprofloxacin or rifampin) recommended by the current guidelines.
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Poore KD, Bauch CT. The impact of aggregating serogroups in dynamic models of Neisseria meningitidis transmission. BMC Infect Dis 2015. [PMID: 26223223 PMCID: PMC4520071 DOI: 10.1186/s12879-015-1015-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Background Neisseria meningitidis (Nm) is a pathogen of multiple serogroups that is highly prevalent in many populations. Serogroups associated with invasive meningococcal disease (IMD) in Canada, for example, include A, B, C, W-135, X and Y. IMD is a rare but serious outcome of Nm infection, and can be prevented with vaccines that target certain serogroups. This has stimulated the development of dynamic models to evaluate vaccine impact. However, these models typically aggregate the various Nm serogroups into a small number of combined groups, instead of modelling each serogroup individually. The impact of aggregation on dynamic Nm model predictions is poorly understood. Our objective was to explore the impact of aggregation on dynamic model predictions. Methods We developed two age-structured agent-based models--a 2-strain model and a 4-strain model--to simulate vaccination programs in the Canadian setting. The 2-strain model was used to explore two different groupings: C, versus all other serogroups combined; and B, versus all other serogroups combined. The 4-strain model used the four groupings: C, B, Neisseria lactamica, versus all other serogroups combined. We compared the predicted impact of monovalent C vaccine, quadrivalent ACWY vaccine (MCV-4), and monovalent B vaccine (4CMenB) on the prevalence of serogroup carriage under these different models. Results The 2-strain and 4-strain models predicted similar overall impacts of vaccines on carriage prevalence, especially with respect to the vaccine-targeted serogroups. However, there were some significant quantitative and qualitative differences. Declines in vaccine-targeted serogroups were more rapid in the 2-strain model than the 4-strain model, for both the C and the 4CMenB vaccines. Sustained oscillations, and evidence for multiple attractors (i.e., different types of dynamics for the same model parameters but different initial conditions), occurred in the 4-strain model but not the 2-strain model. Strain replacement was also more pronounced in the 4-strain model, on account of the 4-strain model spreading prevalence more thinly across groups and thus enhancing competitive interactions. Conclusions Simplifying assumptions like aggregation of serogroups can have significant impacts on dynamic model predictions. Modellers should carefully weigh the advantages and disadvantages of aggregation when formulating models for multi-strain pathogens. Electronic supplementary material The online version of this article (doi:10.1186/s12879-015-1015-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Keith D Poore
- Department of Mathematics and Statistics, University of Guelph, 50 Stone Road East, Guelph, ON, Canada.
| | - Chris T Bauch
- Department of Mathematics and Statistics, University of Guelph, 50 Stone Road East, Guelph, ON, Canada. .,Department of Applied Mathematics, University of Waterloo, 200 University Avenue West, Waterloo, ON, Canada.
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Zalmanovici Trestioreanu A, Fraser A, Gafter‐Gvili A, Paul M, Leibovici L, Cochrane Acute Respiratory Infections Group. Antibiotics for preventing meningococcal infections. Cochrane Database Syst Rev 2013; 2013:CD004785. [PMID: 24163051 PMCID: PMC6698485 DOI: 10.1002/14651858.cd004785.pub5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Meningococcal disease is a contagious bacterial infection caused by Neisseria meningitidis (N. meningitidis). Household contacts have the highest risk of contracting the disease during the first week of a case being detected. Prophylaxis is considered for close contacts of people with a meningococcal infection and populations with known high carriage rates. OBJECTIVES To study the effectiveness, adverse events and development of drug resistance of different antibiotics as prophylactic treatment regimens for meningococcal infection. SEARCH METHODS We searched CENTRAL 2013, Issue 6, MEDLINE (January 1966 to June week 1, 2013), EMBASE (1980 to June 2013) and LILACS (1982 to June 2013). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs addressing the effectiveness of different antibiotics for: (a) prophylaxis against meningococcal disease; (b) eradication of N. meningitidis. DATA COLLECTION AND ANALYSIS Two review authors independently appraised the quality and extracted data from the included trials. We analysed dichotomous data by calculating the risk ratio (RR) and 95% confidence interval (CI) for each trial. MAIN RESULTS No new trials were found for inclusion in this update. We included 24 studies; 19 including 2531 randomised participants and five including 4354 cluster-randomised participants. There were no cases of meningococcal disease during follow-up in the trials, thus effectiveness regarding prevention of future disease cannot be directly assessed.Mortality that was reported in one study was not related to meningococcal disease or treatment. Ciprofloxacin (RR 0.04; 95% CI 0.01 to 0.12), rifampin (rifampicin) (RR 0.17; 95% CI 0.13 to 0.24), minocycline (RR 0.28; 95% CI 0.21 to 0.37) and penicillin (RR 0.47; 95% CI 0.24 to 0.94) proved effective at eradicating N. meningitidis one week after treatment when compared with placebo. Rifampin (RR 0.20; 95% CI 0.14 to 0.29), ciprofloxacin (RR 0.03; 95% CI 0.00 to 0.42) and penicillin (RR 0.63; 95% CI 0.51 to 0.79) still proved effective at one to two weeks. Rifampin was effective compared to placebo up to four weeks after treatment but resistant isolates were seen following prophylactic treatment. No trials evaluated ceftriaxone against placebo but rifampin was less effective than ceftriaxone after one to two weeks of follow-up (RR 5.93; 95% CI 1.22 to 28.68). Mild adverse events associated with treatment were observed. AUTHORS' CONCLUSIONS Using rifampin during an outbreak may lead to the circulation of resistant isolates. Use of ciprofloxacin, ceftriaxone or penicillin should be considered. All four agents were effective for up to two weeks follow-up, though more trials comparing the effectiveness of these agents for eradicating N. meningitidis would provide important insights.
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Affiliation(s)
| | - Abigail Fraser
- University of Bristol, Oakfield HouseMRC Integrative Epidemiology Unit at the University of BristolOakfield RoadBristolUKBS8 2BN
| | - Anat Gafter‐Gvili
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine E39 Jabotinski StreetPetah TikvaIsrael49100
| | - Mical Paul
- Rambam Health Care CampusDivision of Infectious DiseasesHa‐aliya 8 StHaifaIsrael33705
| | - Leonard Leibovici
- Beilinson Hospital, Rabin Medical CenterDepartment of Medicine E39 Jabotinski StreetPetah TikvaIsrael49100
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Freeman CD, Nightingale CH, Quintiliani R. Minocycline: old and new therapeutic uses. Int J Antimicrob Agents 2012; 4:325-35. [PMID: 18611625 DOI: 10.1016/0924-8579(94)90034-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/1994] [Indexed: 10/27/2022]
Abstract
Since the introduction of minocycline HCl in the late 1960's, it has been used for disease states that have ranged from typical community-acquired infectious diseases to others that are non-infectious, such as resistant rheumatoid arthritis. Owing to its high penetration characteristics throughout the body, minocycline can be used in the treatment of a wide variety of extracellular and intracellular pathogens. This review examines the known and potential therapeutic uses of minocycline in a clinical setting.
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Affiliation(s)
- C D Freeman
- Department of Pharmacy Practice, College of Pharmacy, Butler University, Indianapolis, IN 46208, USA; Department of Pharmacy, Community Hospital East, Indianapolis, IN, USA
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What is the evidence for giving chemoprophylaxis to children or students attending the same preschool, school or college as a case of meningococcal disease? Epidemiol Infect 2011; 139:1645-55. [PMID: 21835067 DOI: 10.1017/s0950268811001439] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We performed a systematic literature review to assess the effectiveness of chemoprophylaxis for contacts of sporadic cases of invasive meningococcal disease (IMD) in educational settings. No studies directly compared IMD risk in contacts with/without chemoprophylaxis. However, compared to the background incidence, an elevated IMD risk was identified in settings without a general recommendation for chemoprophylaxis in pre-schools [pooled risk difference (RD) 58·2/10⁵, 95% confidence interval (CI) 27·3-89·0] and primary schools (pooled RD 4·9/10⁵, 95% CI 2·9-6·9) in the ~30 days after contact with a sporadic IMD case, but not in other educational settings. Thus, limited but consistent evidence suggests the risk of IMD in pre-school contacts of sporadic IMD cases is significantly increased above the background risk, but lower than in household contacts (pooled RD for household contacts with no chemoprophylaxis vs. background incidence: 480·1/10⁵, 95% CI 321·5-639·9). We recommend chemoprophylaxis for pre-school contacts depending on an assessment of duration and closeness of contact.
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Zalmanovici Trestioreanu A, Fraser A, Gafter-Gvili A, Paul M, Leibovici L. Antibiotics for preventing meningococcal infections. Cochrane Database Syst Rev 2011:CD004785. [PMID: 21833949 DOI: 10.1002/14651858.cd004785.pub4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Meningococcal disease is a contagious bacterial infection caused by Neisseria meningitidis (N. meningitidis). Household contacts have the highest risk of contracting the disease during the first week of a case being detected. Prophylaxis is considered for close contacts of people with a meningococcal infection and populations with known high carriage rates. OBJECTIVES To study the effectiveness of different prophylactic treatment regimens. SEARCH STRATEGY We searched the Cochrane Central Register of Controlled Trials (CENTRAL 2011, Issue 2) which contains the Cochrane Acute Respiratory Infections Group Specialised Register, MEDLINE (January 1966 to May Week 3, 2011), EMBASE (1980 to May 2011) and LILACS (1982 to May 2011). SELECTION CRITERIA Randomised controlled trials (RCTs) or quasi-RCTs addressing the effectiveness of different antibiotics for: (a) prophylaxis against meningococcal disease; (b) eradication of N. meningitidis. DATA COLLECTION AND ANALYSIS Two review authors independently appraised the quality and extracted data from the included trials. We analysed dichotomous data by calculating the risk ratio (RR) and 95% confidence interval (CI) for each trial. MAIN RESULTS We included 24 studies; 19 including 2531 randomised participants and five including 4354 cluster-randomised participants. There were no cases of meningococcal disease during follow up in the trials, thus effectiveness regarding prevention of future disease cannot be directly assessed.Ciprofloxacin (RR 0.04; 95% CI 0.01 to 0.12), rifampin (rifampicin) (RR 0.17; 95% CI 0.13 to 0.24), minocycline (RR 0.28; 95% CI 0.21 to 0.37) and penicillin (RR 0.47; 95% CI 0.24 to 0.94) proved effective at eradicating N. meningitidis one week after treatment when compared with placebo. Rifampin (RR 0.20; 95% CI 0.14 to 0.29), ciprofloxacin (RR 0.03; 95% CI 0.00 to 0.42) and penicillin (RR 0.63; 95% CI 0.51 to 0.79) still proved effective at one to two weeks. Rifampin was effective compared to placebo up to four weeks after treatment but resistant isolates were seen following prophylactic treatment. No trials evaluated ceftriaxone against placebo but ceftriaxone was more effective than rifampin after one to two weeks of follow up (RR 5.93; 95% CI 1.22 to 28.68). Mild adverse events associated with treatment were observed. AUTHORS' CONCLUSIONS Using rifampin during an outbreak may lead to the circulation of resistant isolates. Use of ciprofloxacin, ceftriaxone or penicillin should be considered. All four agents were effective for up to two weeks follow up, though more trials comparing the effectiveness of these agents for eradicating N. meningitidis would provide important insights.
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Affiliation(s)
- Anca Zalmanovici Trestioreanu
- Department of Family Medicine, Beilinson Campus, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva, Israel, 49100
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Abstract
BACKGROUND Meningococcal disease is a contagious bacterial disease caused by Neisseria meningitidis (N. meningitidis). Household contacts have the highest documented risk of the disease during the first seven days of a case being detected. Prophylaxis is, therefore, considered for those in close contact with people with a meningococcal infection and in populations with known high carriage rates as carriers are at increased risk of disease and may pose a risk of infection to others. OBJECTIVES To study the effectiveness of different prophylactic treatment regimens in: (1) preventing secondary cases of meningococcal disease after contact with someone with the disease; (2) preventing cases of meningococcal disease in populations with a high rate of N. meningitidis carriers; (3) eradicating N. meningitidis from the pharynx in healthy carriers of N. meningitidis. This review also addresses the issues of adverse effects of prophylaxis and development of drug resistance. SEARCH STRATEGY Electronic searches on the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 3, 2006), MEDLINE (January 1966 to June 2006), EMBASE (1980 to June 2006), LILACS (1982 to June 2006); and searching of references of all identified studies were performed. SELECTION CRITERIA Randomised or quasi-randomised clinical trials addressing the effectiveness of different antibiotic treatments for: (a) prophylaxis against meningococcal disease; (b) eradication of N. meningitidis. DATA COLLECTION AND ANALYSIS Two reviewers independently appraised the quality of each trial and extracted data from the included trials. Dichotomous data were analysed by calculating the relative risk (RR) and 95% confidence interval for each trial. MAIN RESULTS There were no cases of meningococcal disease during follow up in any of the trials, thus effectiveness regarding prevention of future disease cannot be directly assessed. Ciprofloxacin (RR 0.04; 95% CI 0.01 to 0.12), rifampin (rifampicin) (RR 0.17; 95% CI 0.12 to 0.24), minocycline (RR 0.30; 95% CI 0.19 to 0.45) and ampicillin (RR 0.41; 95% CI 0.25 to 0.66) proved effective at eradicating N. meningitidis one week after treatment when compared with placebo. However, only rifampin (RR 0.20; 95% CI 0.14 to 0.29) and ciprofloxacin (RR 0.03; 95% CI 0.00 to 0.42) still proved effective at one to two weeks. Rifampin continued to be effective compared to placebo for up to four weeks after treatment but resistant isolates were seen following prophylactic treatment. No trials evaluated ceftriaxone against placebo but ceftriaxone was more effective than rifampin after one to two weeks of follow up (RR 5.93; 95% CI 1.22 to 28.68). AUTHORS' CONCLUSIONS Given the fact that the use of rifampin in an outbreak setting might lead to the circulation of isolates resistant to rifampin, use of ciprofloxacin or ceftriaxone should be considered. Evidence suggests that all three agents are effective with up to two weeks follow up. Placebo-controlled trials do not seem ethical as prophylactic treatment has been proven to reduce the risk of disease among household contacts. More trials comparing the effectiveness of ceftriaxone, ciprofloxacin and rifampin for eradicating N. meningitidis would provide important insights.
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Affiliation(s)
- A Fraser
- University of Bristol, Canynge Hall, Department of Social Medicine, Whiteladies Road, Bristol, UK.
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8
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Abstract
Neisseria meningitidis is the leading cause of bacterial meningitis in the United States and worldwide. A serogroup A/C/W-135/Y polysaccharide meningococcal vaccine has been licensed in the United States since 1981 but has not been used universally outside of the military. On 14 January 2005, a polysaccharide conjugate vaccine that covers meningococcal serogroups A, C, W-135, and Y was licensed in the United States for 11- to 55-year-olds and is now recommended for the routine immunization of adolescents and other high-risk groups. This review covers the changing epidemiology of meningococcal disease in the United States, issues related to vaccine prevention, and recommendations on the use of the new vaccine.
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Affiliation(s)
- Lee H Harrison
- Infectious Diseases Epidemiology Research Unit, 521 Parran Hall, 130 Desoto St., University of Pittsburgh, Pittsburgh, PA 15261, USA.
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Fraser A, Gafter-Gvili A, Paul M, Leibovici L. Prophylactic use of antibiotics for prevention of meningococcal infections: systematic review and meta-analysis of randomised trials. Eur J Clin Microbiol Infect Dis 2005; 24:172-81. [PMID: 15782277 DOI: 10.1007/s10096-005-1297-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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.
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Affiliation(s)
- A Fraser
- Department of Medicine E, Rabin Medical Center, Beilinson Campus, Petah-Tiqva, 49100, Israel.
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Abstract
BACKGROUND Meningococcal disease is a contagious bacterial disease caused by Neisseria meningitidis (N. meningitidis). The highest documented risk of disease is for household contacts during the first seven days of a case being detected. Prophylaxis is considered for those in close contact with people with a meningococcal infection and in populations with known high carriage rates as carriers are at increased risk of disease and may pose a risk of infection to others. OBJECTIVES To study the effectiveness of different prophylactic treatment regimens in: (1) preventing secondary cases of meningococcal disease after contact with a case; (2) preventing cases of meningococcal disease in populations with a high rate of N. meningitidis carriers; (3) eradicating N. meningitidis from the pharynx in healthy carriers of N. meningitidis;This review also addresses the issues of adverse affects and development of drug resistance. SEARCH STRATEGY Electronic searches on The Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2004), MEDLINE (January 1966 to July 2004), EMBASE (1980 to September 2004), LILACS (1982 to July 2004), and searches of references of all identified studies. SELECTION CRITERIA Randomised or quasi-randomised clinical trials addressing the effectiveness of different antibiotic treatments for (a) prophylaxis of/against meningococcal disease; (b) eradication of N. meningitidis. DATA COLLECTION AND ANALYSIS Two reviewers independently appraised the quality of each trial and extracted data from the included trials. Dichotomous data were analysed by calculating the relative risk (RR) and 95% confidence interval for each trial. MAIN RESULTS There were no cases of meningococcal disease during follow up in any of the trials, thus effectiveness regarding prevention of future disease cannot be directly assessed. Ciprofloxacin (relative risk (RR) 0.04; 95% CI 0.01 to 0.12), rifampin (RR 0.17; 95% CI 0.12 0.24), minocycline (RR = 0.30; 95% CI 0.19 to 0.45) and ampicillin (RR 0.41; 95% CI 0.25 0.66) proved effective at eradicating N. meningitidis one week after treatment, compared with placebo. However, after one to two weeks only rifampin (RR 0.20; 95% CI 0.14 to 0.29) and ciprofloxacin (RR 0.03; 95% CI 0.00 to 0.42) still proved effective. No trials evaluated ceftriaxone against placebo. Ceftriaxone was more effective than rifampin, after one to two weeks of follow up (RR 5.93; 95% CI 1.22 to 28.68). Rifampin continued to be effective compared to placebo until up to four weeks of post treatment follow up but resistant isolates were seen following prophylactic treatment. AUTHORS' CONCLUSIONS Given the fact that the use of rifampin in an outbreak setting might lead to the circulation of isolates resistant to rifampin, use of ciprofloxacin or ceftriaxone should be considered.Placebo-controlled trials do not seem ethical as prophylactic treatment has been proven to reduce the risk of disease among household contacts. More trials comparing the effectiveness of ceftriaxone, ciprofloxacin and rifampin for eradicating N. meningitidis could provide important insights.
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Affiliation(s)
- A Fraser
- Internal Medicine E, Rabin Medical Center, Beilinson Campus, Petach-Tikva, Israel, 49100.
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Simmons G, Jones N, Calder L. Equivalence of ceftriaxone and rifampicin in eliminating nasopharyngeal carriage of serogroup B Neisseria meningitidis. J Antimicrob Chemother 2000; 45:909-11. [PMID: 10837450 DOI: 10.1093/jac/45.6.909] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
The efficacy of ceftriaxone in eliminating nasopharyngeal carriage of Neisseria meningitidis was compared with that of rifampicin during an epidemic of serogroup B meningococcal disease in Auckland, New Zealand. Household contacts of cases had a throat swab taken and were randomized to treatment. Carriers had a repeat swab taken 6 days later to determine efficacy of treatment. Ceftriaxone (98.2%) was equivalent to rifampicin (97.6%) in eliminating serogroup B N. meningitidis. It is cheaper than rifampicin and has the advantage of full compliance and fewer contraindications, but its acceptability by patients may limit its use as a first-line prophylactic agent.
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Affiliation(s)
- G Simmons
- Auckland Healthcare Public Health Protection, Auckland, New Zealand.
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12
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Abstract
Meningococcal infection is a contagious disease that is spread via the respiratory route through pharyngeal secretions. Clinical manifestations range from occult bacteremia to overwhelming septicemia or meningitis. Skin manifestations often develop and may be the first sign that leads to clinical suspicion of meningococcemia. Treatment consists of antibiotic therapy and supportive care, which may include aggressive fluid resuscitation, oxygen, ventilatory support, and inotropic support. The use of chemoprophylaxis and in certain circumstances vaccination are important in preventing secondary cases of meningococcal disease.
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Characterization of epidemic and nonepidemic Neisseria meningitidis serogroup A strains from Sudan and Sweden. J Clin Microbiol 1990; 28:1711-9. [PMID: 1975593 PMCID: PMC268034 DOI: 10.1128/jcm.28.8.1711-1719.1990] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
A random selection of 25 strains isolated during an epidemic caused by serogroup A Neisseria meningitidis in Sudan (1988), 3 preepidemic meningococcal strains (1985), and 26 serogroup A strains isolated from sporadic cases of meningitis in Sweden (1973 to 1987) were assessed for multilocus enzyme genotypes (ETs), DNA restriction enzyme patterns, outer membrane proteins, lipopolysaccharides, pilus formation, and antibiograms. All of the 25 Sudanese epidemic isolates and 22 of the Swedish strains were of the same or closely related ETs (ETs 3, 4, and 5), corresponding to clone III-1, which has been responsible for two pandemic waves in the last three decades. The earlier pandemic involved Scandinavia, and the last one caused an outbreak during the pilgrimage to Mecca, Saudi Arabia (August 1987), spreading to Sudan, Chad, and Ethiopia. The three Sudanese preepidemic isolates (1985) were clone IV-1 (sulfonamide susceptible), which has been resident in the African meningitis belt for the last 25 years. The uniformity of clone III-1 strains (all sulfonamide resistant) from Sudan and Sweden was confirmed by DNA restriction enzyme patterns. ETs 3, 4, and 5 from Sudan and Sweden had 86 to 100% similarity to a Swedish clone III-1 reference strain, whereas ETs 1, 2, 6, and 7 showed 50 to 80% similarity. Class 1 protein for clone III-1 showed serosubtype antigens P1.9 and P1.x, whereas ET6 strains (clone IV-1) had serosubtype P1.7. Lipopolysaccharides were variable in the Sudanese and Swedish strains. Pili were expressed in all clone III-1 isolates from Sudan and Sweden but in none of the clone IV-1 isolates (Sudan, 1985).
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Salih MA. Childhood acute bacterial meningitis in the Sudan: an epidemiological, clinical and laboratory study. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES. SUPPLEMENTUM 1989; 66:1-103. [PMID: 2115207 DOI: 10.3109/inf.1989.21.suppl-66.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
The aims of the present study were to document the epidemiology, clinical features and complications of childhood acute bacterial meningitis (ABM) in The Sudan during both an inter-epidemic (endemic) period (1985-1986), and the 1988 serogroup A epidemic; and to examine the phenotypic and genetic similarities and differences of Neisseria meningitidis strains isolated in The Sudan and Sweden. A new enzyme immunoassay test (Pharmacia Meningitis EIA-Test) was evaluated as a potential rapid diagnostic method for the detection of Haemophilus influenzae (HI) type b, Neisseria meningitidis (MC) and Streptococcus pneumoniae (PNC). The test was found to have good sensitivity (0.86) and specificity (0.95) in the inter-epidemic period; and to be adaptable to the field work in The Sudan during the 1988 MC epidemic. During inter-epidemic (endemic) situations in The Sudan, greater than 90% of childhood ABM was caused by one of the three organisms, HI type b, MC and PNC. HI accounted for 57% of the cases. The peak incidence (76%) of HI cases was in infants (less than 12 months) similar to the situation in other African countries. The overall case fatality ratio was 18.6%. Prospective follow-up of survivors for 3-4 years revealed that an additional 43% either died or had permanent neurological complications, the most prevalent and persistent of which was sensorineural hearing loss recorded in 22% of long term survivors. Post-meningitic children were found to have significantly lower intelligence quotients (92.3 +/- 13.9) than their sibling controls (100.7 +/- 10.2, P = 0.029). Features of the large serogroup A sulphonamide resistant MC epidemic (February-August 1988) in Khartoum are described. An estimated annual incidence of 1,679/100,000 was recorded at the peak of the epidemic. The highest attack rate was in young children less than 5 years, as in many other African countries; nevertheless, a high morbidity was observed in adults (31% of the cases greater than or equal to 20 years). The clinical features, mortality (6.3%) and short term sequelae in Sudanese children were generally within the framework described for MC disease elsewhere. Detailed analysis of MC isolates from Sudan and Sweden by characterizing their electrophoretic enzyme types, DNA restriction endonuclease pattern and outer membrane proteins, revealed that serogroup A MC clone III-1 was responsible of The Sudan epidemic in 1988 and has been the dominant serogroup A organism in Sweden since 1973. The Sudanese strains isolated prior to the epidemic (1985) were clone IV-1.(ABSTRACT TRUNCATED AT 250 WORDS)
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MESH Headings
- Acute Disease
- Adolescent
- Adult
- Child
- Child, Preschool
- Disease Outbreaks
- Female
- Hearing Loss, Sensorineural/etiology
- Humans
- Immunoenzyme Techniques
- Infant
- Male
- Meningitis/complications
- Meningitis/diagnosis
- Meningitis/epidemiology
- Meningitis, Haemophilus/complications
- Meningitis, Haemophilus/diagnosis
- Meningitis, Haemophilus/epidemiology
- Meningitis, Meningococcal/complications
- Meningitis, Meningococcal/diagnosis
- Meningitis, Meningococcal/epidemiology
- Meningitis, Pneumococcal/complications
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/epidemiology
- Neisseria meningitidis/classification
- Prospective Studies
- Sudan/epidemiology
- Sweden
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Affiliation(s)
- M A Salih
- Department of Pediatrics, University Hospital, Uppsala, Sweden
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Schwartz B, Al-Tobaiqi A, Al-Ruwais A, Fontaine RE, A'ashi J, Hightower AW, Broome CV, Music SI. Comparative efficacy of ceftriaxone and rifampicin in eradicating pharyngeal carriage of group A Neisseria meningitidis. Lancet 1988; 1:1239-42. [PMID: 2897515 DOI: 10.1016/s0140-6736(88)92069-7] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
During an outbreak of meningococcal meningitis in Saudi Arabia, oral rifampicin (four doses in two days) was compared with a single intramuscular dose of ceftriaxone for prophylaxis in family contacts of patients with meningococcal disease. Pharyngeal samples were taken for culture before and 1 and 2 weeks after administration. Both follow-up cultures indicated that ceftriaxone was significantly more effective. At 1 week the eradication rates for ceftriaxone and rifampicin were 97% and 75%; at 2 weeks they were 97% and 81%, respectively. No serious side-effects were associated with either agent. Ceftriaxone may provide an effective alternative to rifampicin for prophylaxis in meningococcal contacts.
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Affiliation(s)
- B Schwartz
- Division of Bacterial Diseases, Centers for Disease Control, Atlanta, GA 30333
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Stroffolini T, Curiano CM. Public health management of meningococcal disease: indications from a one year national survey in Italy. Public Health 1987; 101:3-8. [PMID: 3562767 DOI: 10.1016/s0033-3506(87)80022-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Crosson FJ, Black SB, Trumpp CE, Grossman M, Lé CT, Yeager AS. Infections in day-care centers. CURRENT PROBLEMS IN PEDIATRICS 1986; 16:121-84. [PMID: 3533444 PMCID: PMC7130649 DOI: 10.1016/0045-9380(86)90020-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
Close contact of patients with bacterial meningitis that is caused by either Haemophilus influenzae type b or Neisseria meningitidis are at an increased risk of developing invasive infections with these bacteria. Chemoprophylaxis with rifampin and immunoprophylaxis with vaccines may prevent some secondary infections.
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Care of the Infant and Child. Fam Med 1983. [DOI: 10.1007/978-1-4757-4002-8_41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Jacobs RF, Yamauchi T. Recurrent meningococcal meningitis caused by poly groups X-W135: importance of chemoprophylaxis. INFECTION CONTROL : IC 1981; 2:312-4. [PMID: 6912219 DOI: 10.1017/s0195941700055351] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Presented is a case report and literature review of the causes of recurrent meningococcal meningitis. After all factors were analyzed, the cause of reinfection in this child was postulated to be ineffective chemoprophylaxis of close contacts following the initial episode. The efficacy of chemoprophylaxis in household members and close contacts in meningococcal disease, although not demonstrated in controlled trials, has been recommended since 1974 by the Meningococcal Disease Surveillance Group. Considering known carriage rates, reports of secondary infections in close contacts, reinfection in the same person, and a high case fatality ratio, chemoprophylaxis in such cases seems justified.
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Daum RS, Glode MP, Goldmann DA, Halsey N, Ambrosino D, Welborn C, Mather FJ, Willard JE, Sullivan B, Murray M, Johansen T. Rifampin chemoprophylaxis for household contacts of patients with invasive infections due to Haemophilus influenzae type b. J Pediatr 1981; 98:485-91. [PMID: 7009819 DOI: 10.1016/s0022-3476(81)80731-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
To determine the efficacy of rifampin chemoprophylaxis in eradication of oropharyngeal carriage of Haemophilus influenzae type b, we conducted a multicenter, double-blind, placebo-controlled trial among household contacts of patients hospitalized for invasive HIB infection. Seventy-nine index patients and 400 close contacts were studied; 26.5% of contacts were colonized. The efficacy of rifampin (10 mg/kg/dose, 600 mg/dose maximum, twice daily for two days) in eradicating carriage was 52% and varied with age (75.6% in persons greater than or equal to 5 and 27% in those less than 5 years). Eradication rates in those less than 5 years were not significantly better than for placebo. No resistant isolates were encountered in sensitivity testing. The low efficacy of this rifampin regimen in young children precludes its routine use as a chemoprophylactic agent for family contacts. The occurrence of three cases of invasive HIB infection in individuals outside the defined contact group raises concern regarding the efficacy of any chemoprophylactic regimen.
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Blakebrough IS, Gilles HM. The effect of rifampicin on meningococcal carriage in family contacts in northern Nigeria. J Infect 1980; 2:137-43. [PMID: 6821084 DOI: 10.1016/s0163-4453(80)91159-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Menendez M, Cintado C, Macias P. Chimioprophylaxie des affections méningococciques par la minocycline. Effets secondaires observés chez l'enfant. Med Mal Infect 1980. [DOI: 10.1016/s0399-077x(80)80071-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nessi R, Fowst G. Clinical use of rifampicin in combination for non-mycobacterial infections: a survey of published evidence. J Int Med Res 1979; 7:179-86. [PMID: 378728 DOI: 10.1177/030006057900700304] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The literature on the clinical use of rifampicin in combination for the treatment of non-mycobacterial diseases is reviewed. From the published evidence, the most promising associations are, for staphylococcal infections, gentamicin, erythromycin, kanamycin and fusidic acid. In the field of Gram-negative infections, Psuedomonas-induced sepsis in particular, data are not so impressive but promising results have been obtained with the associated use of rifampicin and gentamicin or colistin. Some systemic fungal diseases may be successfully treated with rifampicin in combination with amphotericin-B. Although only few reports are available on this subject, the importance of such an application is stressed in view of the severity of these diseases and of the lack of appropriate treatments.
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Hassan-King M, Greenwood BM, Whittle HC, Abbott JD, Sutcliffe EM. An epidemic of meningococcal infection at Zaria, Northern Nigeria. 3. Meningococcal carriage. Trans R Soc Trop Med Hyg 1979; 73:567-73. [PMID: 531911 DOI: 10.1016/0035-9203(79)90054-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Meningococcal carriage was studied in household contacts of patients with group A meningococcal disease and in controls. The carriage rate of group A meningococci among 1,098 household contacts was low (3.8%) and only slightly higher than the carriage rate found among 416 controls (2.6%). However, higher carrier rates were found among those in close contact with a patient. Carriage was found most frequently among children and young adults and was commoner in adult females than in adult males. Sulphonamides had no effect on carriage and all 60 strains tested in vitro were resistant to sodium sulphadiazine at a concentration of 10 micrograms/ml.
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Jacoby I, Mandell LA, Weinstein L. The chemoprophylaxis of infection. A brief review of recent studies. Med Clin North Am 1978; 62:1083-98. [PMID: 732383 DOI: 10.1016/s0025-7125(16)31756-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Tramont EC, Artenstein MS. Chemoprophylaxis of Meningococcal Meningitis. Chemotherapy 1976. [DOI: 10.1007/978-1-4613-4346-2_7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
Several recent reports have indicated that minocycline, a drug effective for meningococcal disease prophylaxis, is associated with a high incidence of vestibular side effects. In January 1975, a questionnaire on adverse reactions was completed by all 29 staff members of a North Georgia hospital who had taken minocycline at the recommended dosage after exposure to a suspected meningococcal meningitis case and by 25 age-, sex-, and occupation-matched non-treated controls. In the treated group 86% experienced moderate to severe vestibular symptoms; 84% of the symptomatic persons experienced their onset after one or two doses of 100 mg. Fifty-two percent of the treated staff members stopped taking the medication because of these effects. The symptoms resolved within 48 h after affected persons discontinued the medication. Until the safety of minocycline can be reestablished, rifampin is recommended for meningococcal disease prophylaxis, and alternative drugs are encouraged for other indications.
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