Zalmanovici Trestioreanu Anca, Fraser Abigail, Gafter-Gvili Anat, Paul Mical, Leibovici Leonard
Department of Family Medicine, Beilinson Campus, Rabin Medical Center, 39 Jabotinski Street, Petah Tikva, Israel, 49100.
Cochrane Database Syst Rev. 2011 Aug 10(8):CD004785. doi: 10.1002/14651858.CD004785.pub4.
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.
To study the effectiveness of different prophylactic treatment regimens.
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).
Randomised controlled trials (RCTs) or quasi-RCTs addressing the effectiveness of different antibiotics for: (a) prophylaxis against meningococcal disease; (b) eradication of N. meningitidis.
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.
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.
脑膜炎球菌病是由脑膜炎奈瑟菌引起的一种传染性细菌感染。家庭接触者在病例被发现的第一周感染该病的风险最高。对于脑膜炎球菌感染患者的密切接触者以及已知带菌率高的人群，会考虑进行预防治疗。
研究不同预防治疗方案的有效性。
我们检索了Cochrane对照试验中心注册库（CENTRAL 2011年第2期），其中包含Cochrane急性呼吸道感染小组专业注册库、MEDLINE（1966年1月至2011年5月第3周）、EMBASE（1980年至2011年5月）和LILACS（1982年至2011年5月）。
针对不同抗生素对以下方面有效性的随机对照试验（RCT）或半随机对照试验：（a）预防脑膜炎球菌病；（b）根除脑膜炎奈瑟菌。
两位综述作者独立评估纳入试验的质量并提取数据。我们通过计算每个试验的风险比（RR）和95%置信区间（CI）来分析二分数据。
我们纳入了24项研究；19项研究包括2531名随机参与者，5项研究包括4354名整群随机参与者。在试验随访期间没有脑膜炎球菌病病例，因此无法直接评估预防未来疾病的有效性。与安慰剂相比，环丙沙星（RR 0.04；95% CI 0.01至0.12）、利福平（RR 0.17；95% CI 0.13至0.24）、米诺环素（RR 0.28；95% CI 0.21至0.37）和青霉素（RR 0.47；95% CI 0.24至0.94）在治疗一周后证明对根除脑膜炎奈瑟菌有效。利福平（RR 0.20；95% CI 0.14至0.29）、环丙沙星（RR 0.03；95% CI 0.00至0.42）和青霉素（RR 0.63；95% CI 0.51至0.79）在一至两周时仍被证明有效。利福平在治疗后四周内与安慰剂相比有效，但预防治疗后出现了耐药菌株。没有试验评估头孢曲松与安慰剂的对比情况，但在随访一至两周后，头孢曲松比利福平更有效（RR 5.93；95% CI 1.22至28.68）。观察到与治疗相关的轻度不良事件。
在疫情期间使用利福平可能导致耐药菌株的传播。应考虑使用环丙沙星、头孢曲松或青霉素。所有这四种药物在长达两周的随访中都是有效的，不过更多比较这些药物根除脑膜炎奈瑟菌有效性的试验将提供重要的见解。
