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PubMed2005

Prophylactic use of antibiotics for prevention of meningococcal infections: systematic review and meta-analysis of randomised trials.

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.

Anti-Bacterial Agents↗
PubMed1994

Epidemiology, management, and prevention of meningococcal infections.

Neisseria meningitidis is the cause of significant morbidity and mortality worldwide, both in epidemic and endemic disease form. The use of serotyping, subtyping, and multilocus electrophoresis has had a significant impact on determination of the epidemiology of meningococcal disease. Recent advances in understanding the pathogenesis of meningococcal disease, include information on the role of cytokines and other inflammatory mediators, which may contribute to establishment of additional diagnostic and treatment options. Early treatment is required to improve outcome along with the use of prophylaxis to prevent secondary disease. Vaccines against groups A, C, Y, and W135, are available but have limitations, with regard to efficacy and duration of protection. Over the past decade there has been rapid progress in the development of a vaccine against group B disease, with protective trials underway in several countries. However, varying results have been found and these vaccines have not reached a stage of providing universal protection against group B meningococcal disease.

Adolescent↗
PubMed1990

Acute meningococcal infection--a case of monoarthrosis.

A case of septic arthritis in the right knee of a six-month-old girl is described. Neisseria meningitidis was grown from the purulent exudate from the knee joint. No other manifestations of meningococcal disease were observed. Complete recovery followed aspiration and treatment with benzyl penicillin.

Acute Disease↗