Cochrane Summaries

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Pre-admission antibiotics for suspected cases of meningococcal disease

Sudarsanam TD, Rupali P, Tharyan P, Abraham O, Thomas K
Published Online: 
2 August 2013

Meningococcal disease is a contagious, bacterial disease caused by Neisseria meningitidis (N. meningitidis) that, if not treated early, can rapidly lead to death or disabling consequences such as visual, hearing and intellectual impairments.

Administering antibiotics as soon as the condition is suspected and before the diagnosis is confirmed, has been advocated to prevent death and disabling consequences. However, this might result in treating people without the disease with unnecessary antibiotics.

This review update evaluated the effectiveness and safety of pre-admission antibiotics versus no pre-admission antibiotics or placebo and different pre-admission antibiotic regimens in preventing death, lack of clinical improvement and disabling consequences in those suspected to have meningococcal disease.

We found no randomised controlled trials comparing pre-admission antibiotics with placebo or no intervention (up to date 3 May 2013). We identified one well conducted trial in Niger, Africa during an epidemic of meningococcal disease in 2005 including 510 adults and children older than two months, suspected to have meningococcal disease but who were not severely ill. They were randomised to receive a single injection of either ceftriaxone (a newer antibiotic) (251 participants) or a long-acting form of chloramphenicol (an older antibiotic) (259 participants) before confirming the diagnosis. Médecins Sans Frontières sponsored this study.

Both antibiotics were effective in preventing death over the first 72 hours in 477 (95%) of the 503 evaluable participants. In the 308 participants with confirmed meningococcal disease, 154/160 (96%) given the newer antibiotic and 143/148 (95.5%) given the older antibiotic survived. Similar proportions with confirmed disease given the newer antibiotic (3/160; 2%) and the older antibiotic (2/148; 2%) did not show a clinical improvement. Those developing disabling consequences with the newer antibiotic (14/154;9%) and with the older antibiotic (9/143; 6%) were similar. However, larger trials from other parts of the world are needed to be fully confident that the two treatments are equally effective. No serious adverse events were reported with either antibiotic.

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. Further trials comparing different antibiotics in suspected meningococcal disease, especially in more severe forms, will provide insights that could help prevent death and the serious consequences of this disease.