E-DRUG: household prevention of meningococcal disease after a case
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[Evidence that chemoprophylaxis in household contacts of meningococcal
disease is effective. Copied as fair use. Thanks to Valeria for spotting.
Which essential drug to use? Chloramphenicol in oil or ceftriaxone? WB]
BMJ��2004;328:1339�(5�June), doi:10.1136/bmj.328.7452.1339
Paper
Effectiveness of antibiotics in preventing meningococcal disease
after a case: systematic review
Bernadette Purcell, specialist registrar1, Susanne Samuelsson,
consultant epidemiologist2, Susan J M Hahn�, European
Programme for Intervention Epidemiology training fellow3, Ingrid
Ehrhard, consultant microbiologist4, Sigrid Heuberger, consultant
microbiologist5, Ivonne Camaroni, European Programme for
Intervention Epidemiology training fellow3, Andr� Charlett, head6,
James M Stuart, consultant epidemiologist1
1 Communicable Disease Surveillance Centre South West,
Gloucester GL10 3RF, 2 Statens Serum Institut, Copenhagen,
Denmark 2300, 3 Communicable Disease Surveillance Centre,
Cardiff, Wales CF4 3QX, 4 Landesuntersuchungsanstalt f�r das
Gesundheits und Veterin�rwesen, Dresden, Germany 01099, 5
National Reference Centre for Meningococci, Graz, Austria A-8010,
6 Public Health Laboratory Service Statistics Unit, Colindale,
London NW9 5EQ
Correspondence to: J Stuart james.stuart@hpa.org.uk
Objective To summarise the evidence for the role of antibiotics in
preventing further cases of meningococcal disease through
chemoprophylaxis given to the index patient, household contacts,
and children in day care settings after a single case.
Design Systematic review.
Methods Studies were identified by searching Embase
(1983-2003), Medline (1965-2003), and CAB Health (1973-2003)
and by contacting the World Health Organization and the European
meningococcal disease surveillance network and examining
references of identified papers. The review included all studies
with at least 10 cases in which outcomes were compared
between treated and untreated groups.
Main outcome measure Subsequent cases of meningococcal
disease 1-30 days after onset of disease in the index patient.
Results Four observational studies and one small trial met the
inclusion criteria. Meta-analysis of studies on chemoprophylaxis
given to household contacts showed a significant reduction in risk
(risk ratio 0.11, 95% confidence interval 0.02 to 0.58). The number
needed to treat to prevent a case was estimated as 218 (121 to
1135). Primary outcome data were not available in studies of
chemoprophylaxis given to the index patient: when prophylaxis had
not been given, rate of carriage after discharge from hospital was
estimated as 3% (0 to 6), probably an underestimate of the true
rate. No studies of chemoprophylaxis in day care settings were
identified that met the inclusion criteria.
Conclusion There have been no high quality experimental trials
looking at control policies for meningococcal disease. The best
available evidence is from retrospective studies. The risk of
meningococcal disease in household contacts of a patient can be
reduced by an estimated 89% if they take antibiotics known to
eradicate meningococcal carriage. Chemoprophylaxis should be
recommended for the index patient and all household contacts.
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