There is no reliable evidence supporting the use of pre-admission antibiotics for suspected cases of non-severe meningococcal disease, according to a Cochrane Database Systematic Review.
Sudarsanam et al. conducted the review to “study the effectiveness and safety of pre-admission antibiotics versus no pre-admission antibiotics or placebo, and different pre-admission antibiotic regimens in decreasing mortality, clinical failure, and morbidity in people suspected of meningococcal disease.”
The researchers were unable to find any RCTs comparing pre-admission antibiotics to no pre-admission antibiotics or placebo. They included one open-label, non-inferiority RCT (n=510), which was conducted during an epidemic in Niger. The trial evaluated a single dose of intramuscular ceftriaxone vs. a single dose of intramuscular long-acting (oily) chloramphenicol.
The trial found that ceftriaxone was not inferior to chloramphenicol in reducing mortality (RR 1.21, 95% CI 0.57 to 2.56; n=503; 308 confirmed meningococcal meningitis; 26 deaths; moderate-quality evidence), clinical failures (RR 0.83, 95% CI 0.32 to 2.15; n=477; 18 clinical failures; moderate-quality evidence), or neurological sequelae (RR 1.29, 95% CI 0.63 to 2.62; n=477; 29 with sequelae; low-quality evidence). No adverse effects of treatment were reported. Estimated treatment costs were similar. There were no data available on sequelae-related disease burden.
The researchers concluded that the single qualifying RCT showed that single intramuscular injections of ceftriaxone and long-acting chloramphenicol were equally effective, safe, and economical in reducing serious outcomes. Therefore, they concluded, “the choice between these antibiotics should be based on affordability, availability, and patterns of antibiotic resistance.”
They noted that “further RCTs comparing different pre-admission antibiotics, accompanied by intensive supportive measures, are ethically justified in people with less severe illness, and are needed to provide reliable evidence in different clinical settings.”
Sudarsanam TD, Rupali P, Tharyan P, Abraham OC, Thomas K. Pre-admission antibiotics for suspected cases of meningococcal disease. Cochrane Database Syst Rev. 2017 Jun 14;6:CD005437.